Clark, Diane K

Clark, Diane K is an individual health care provider with primary practice located at 9427 Sw Barnes Rd Ste 595, Portland OR 97225-6640. She recently has 3 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Acute Care, Physician Assistants & Advanced Practice Nursing Providers / Critical Care Medicine, Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner. Physician Assistants & Advanced Practice Nursing Providers / Acute Care is her primary health care specialty. Clark, Diane K can be contacted via phone (503) 216-1150.

Contact Information

Primary practice address
9427 Sw Barnes Rd Ste 595 Portland OR 97225-6640
Phone: (503) 216-1150
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Acute Care 363LA2100X 278877-4405 Utah
Physician Assistants & Advanced Practice Nursing Providers / Critical Care Medicine 364SC0200X 278877-4405 Utah
Physician Assistants & Advanced Practice Nursing Providers / Acute Care 363LA2100X 201150003NP Oregon
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 201150003NP Oregon

Profile Details

NPI number 1881863488
LBN Legal business name Clark, Diane K
Credentials ACNP
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 27th, 2008
Last updated Feb 19th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1881863488 NPPES
Oregon Other P00957594 RR MEDICARE
Oregon MEDICAID 500631611 RR MEDICARE

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