Provider Demographics
NPI:1831544618
Name:CLARION TELEHEALTH NETWORK, LLC
Entity type:Organization
Organization Name:CLARION TELEHEALTH NETWORK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:KIMBALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-473-8848
Mailing Address - Street 1:4611 RESEARCH PARK CIR STE B227
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-5948
Mailing Address - Country:US
Mailing Address - Phone:801-473-8848
Mailing Address - Fax:610-713-5312
Practice Address - Street 1:4611 RESEARCH PARK CIR STE B227
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-5948
Practice Address - Country:US
Practice Address - Phone:801-473-8848
Practice Address - Fax:610-713-5312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-28
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5206472363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty