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Charlene Clark, FNP
Family Nurse Practitioner in Mountain Home, Idaho
NPI 1144621756

Charlene Clark is a Family Nurse Practitioner based in Caldwell, ID and is specialized in Family. Charlene Clark practices in Mountain Home, ID and has the professional credentials of FNP. The NPI Number for Charlene Clark is 1144621756 and holds a License No. 73782 (Idaho).

The current practice location address for Charlene Clark is 120 Desert Sage Way, Mountain Home, ID and can be reached out via phone at 208-587-3988 and via fax at 208-587-3324.

Location: 120 Desert Sage Way, Mountain Home, ID, 83605-2553
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1144621756
Provider Name
Charlene Clark
Credential
FNP
Provider Entity Type
Individual
Gender
Female
Address
120 Desert Sage Way, Mountain Home, ID, 83605-2553
Phone Number
208-587-3988
Fax Number
208-587-3324
Provider Enumeration Date
09/15/2014
Last Update Date
01/18/2025
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Provider's Legacy Identifiers
Identifier Type State Issuer
19070 01 TN APN LICENSE
institution
Provider Business Practice Location Address Details
Address
120 Desert Sage Way
City
Mountain Home
State
Idaho
Zip
83647-1038
Phone Number
208-587-3988
Fax Number
208-587-3324
person
Provider Business Mailing Address Details
Address
120 Desert Sage Way
City
Mountain Home
State
Idaho
Zip
83647-1038
Phone Number
208-587-3988
Fax Number
208-587-3324
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
Family
Taxonomy
363LF0000X
License No.
73782 (Idaho)
Definition
Definition to come...
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