NPI 1144621756

Charlene Clark, FNP

Practitioner Family Nurse Practitioner Mountain Home, ID

Practice location

Address: 120 Desert Sage Way, Mountain Home, ID 83647-1038
Phone: (208) 587-3988
Fax: (208) 587-3324
Mailing address: 1205 Teton Ave, Caldwell, ID 83605-2553

Registered specialties (3)

Family Nurse Practitioner Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363LF0000X Licence AP61098520 (WA)

Other Nurse Practitioner providers in Idaho →

Family Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363LF0000X Licence 73782 (ID)

Family Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363LF0000X Licence 19070 (TN)

Registry record

NPI: 1144621756
Entity type: Individual
Sex (as registered): Female
NPI issued: 15 Sep 2014
Record last updated: 8 Jan 2025

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.