Clark, Nathaniel

Clark, Nathaniel is an individual health care provider with primary practice located at 409 W Oak St , Carbondale IL 62901-1464. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Interventional Cardiology, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is his primary health care specialty. Clark, Nathaniel can be contacted via phone (618) 529-4455.

Contact Information

Primary practice address
409 W Oak St Carbondale IL 62901-1464
Phone: (618) 529-4455
Fax: (618) 351-1287
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Interventional Cardiology 207RI0011X 085-003278 Illinois
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 085003278 Illinois

Profile Details

NPI number 1063660074
LBN Legal business name Clark, Nathaniel
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 3rd, 2008
Last updated Dec 21st, 2022 - about 4 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 1063660074 NPPES
Illinois Other P00657126 RAILROAD MEDICARE

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