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NPI Code Detail

MEDICARE: HALLIE J CLARK NP

MEDICARE: HALLIE J CLARK NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner28198172AIN
2363L00000XNurse Practitioner71010836AIN

General Provider Information

NPI Number : 1326638537
Entity Type Code : Individual
Provider Name (Legal Business Name) : HALLIE J CLARK NP
Provider Business Mailing Address
First Line : PO BOX 1510
Second Line :
City : EVANSVILLE
State : IN
Zip : 47706-1510
Country : US
Telephone Number : 812-450-6815
Fax Number : 812-450-6822
Provider Business Practice Location Address
First Line : 1204 WILLIAMS ST
Second Line :
City : OAKLAND CITY
State : IN
Zip : 47660-1001
Country : US
Telephone Number : 812-749-6187
Fax Number : 812-749-4966
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/21/2021
Last Update Date : 02/17/2021

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Directions to “ HALLIE J CLARK NP” Practice Location

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