Provider Demographics
NPI:1285240036
Name:CLARK, JAMES DANIEL (DNP, APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:DANIEL
Last Name:CLARK
Suffix:
Gender:M
Credentials:DNP, APRN, FNP-BC
Other - Prefix:
Other - First Name:BEAR
Other - Middle Name:
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DNP, APRN, FNP-BC
Mailing Address - Street 1:7315 212TH ST SW STE 101
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7610
Mailing Address - Country:US
Mailing Address - Phone:425-775-9474
Mailing Address - Fax:425-670-3554
Practice Address - Street 1:7315 212TH ST SW STE 101
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7610
Practice Address - Country:US
Practice Address - Phone:425-775-9474
Practice Address - Fax:425-670-3554
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-17
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY46477364SF0001X
WAAP61135106363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Single Specialty