Healthcare Provider Details

I. General information

NPI: 1730970682
Provider Name (Legal Business Name): BRIANNA CLARK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 S CLOVER DR STE 4
MOSES LAKE WA
98837-9759
US

IV. Provider business mailing address

203 STATTER RD
EPHRATA WA
98823-1552
US

V. Phone/Fax

Practice location:
  • Phone: 509-512-3372
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberARNP.AP.70154816-CNM
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: