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General NPI Number Information
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NPI Number | 1386170348
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Entity Type | Individual
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Provider Name | MICHAEL CLARK FNP-C
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Gender | Male
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 1993 ERRECART BLVD
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City | ELKO
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State | NV
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Zip | 89801-8334
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Country | US
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Telephone | 775-753-1049
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Fax | 775-777-8494
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Provider Business Mailing Address
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Address Line | 317 E 100 N
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City | PRICE
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State | UT
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Zip | 84501-2504
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 812262
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 7198090-3102
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License Number State | UT
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