RICK C. CLARK JR. (NPI# 1033190533) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033190533 |
| Entity Type | Individual |
| Full Name | RICK C. CLARK JR. |
| Credential | PA |
| Practice Address |
220 Bannock St Suite 306 Malad City ID 83252-1256 |
| Mailing Address |
Po Box 126 Suite 306 Malad City ID 83252-0126 |
| Practice Telephone | 2087662600 |
| Practice Fax Number | 2087664258 |
| Mailing Telephone | 2087662231 |
| Mailing Fax Number | 2087664819 |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2013-07-22 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA-749 | ID | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265520977 | Rick G Clark | Family Medicine | 1394 W 16th St, Yuma, AZ 85364-4430 | 2006-10-10 |
| Street Address |
220 BANNOCK ST SUITE 306 |
| City | MALAD CITY |
| State | ID |
| Zip Code | 83252-1256 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841289659 | Shane Keith Anderson | Internal Medicine | 220 Bannock St, Malad City, ID 83252-1256 | 2005-10-14 |
| 1669026845 | Karen Marie Beck | Nurse Practitioner | 220 Bannock St, Malad City, ID 83252-5068 | 2019-07-26 |
| 1609341098 | Ariel Shantay Avis Taysom | Physician Assistant | 220 Bannock St, Malad City, ID 83252-5068 | 2018-10-11 |
| 1134417843 | Jennifer Felter | Nurse Practitioner | 220 Bannock St, Malad City, ID 83252-5068 | 2011-07-14 |
| 1225276454 | Oneida County Hospital | Clinic/Center | 220 Bannock St, Malad City, ID 83252-5068 | 2009-01-26 |
| 1275735045 | James William Pickett | Family Medicine | 220 Bannock St, Malad City, ID 83252-5068 | 2007-06-04 |
| 1134257876 | Mel Bingham | Physician Assistant | 220 Bannock St, Malad City, ID 83252-5068 | 2007-03-02 |
| 1710041785 | Oneida County Hospital | Clinic/Center | 220 Bannock St, Malad City, ID 83252-1256 | 2006-12-21 |
| 1639283302 | Catherine M. Harmston | Nurse Practitioner | 220 Bannock St, Malad City, ID 83252-5068 | 2006-08-18 |
| 1922026467 | Robert Todd Gillespie | Physician Assistant | 220 Bannock St, Suite B, Malad City, ID 83252-1256 | 2006-07-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003179706 | David Teeples | Family Medicine | 220 Bannock Street, Malad, ID 83252 | 2012-06-19 |
| 1396046835 | A To Z Family Services, Inc. | Social Worker | 44 N Main, Malad, ID 83252 | 2010-11-16 |
| 1942855879 | Tylee Skinner | Behavior Technician | 611 N 500 W, Malad City, ID 83252-1021 | 2019-08-07 |
| 1982738662 | Southeastern Idaho Medical Clinics | Family Medicine | 230 W 200 N, Malad City, ID 83252-1109 | 2007-03-15 |
| 1861934473 | Bcs Healthcare, LLC | Nurse Practitioner | 300 N 100 W, Malad City, ID 83252-1144 | 2016-11-14 |
| 1689005845 | Rosemary Wells | Counselor | 444 N Main St, Malad City, ID 83252-1156 | 2013-12-12 |
| 1730459397 | A To Z Family Services | Clinic/Center | 44 N Main St, Malad City, ID 83252-1200 | 2012-01-12 |
| 1083913164 | Dallas R Spencer | Social Worker | 44 N Main St, Malad City, ID 83252-1200 | 2011-03-15 |
| 1003113390 | Kelly Steven Piersanti | Counselor | 44 N Main St, Malad City, ID 83252-1200 | 2011-02-22 |
| 1346477668 | Ronald Eugene Perry | Chiropractor | 60 N Main St, Malad City, ID 83252-1200 | 2009-06-12 |
| Find all providers in zip 83252 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609341098 | Ariel Shantay Avis Taysom | Physician Assistant | 220 Bannock St, Malad City, ID 83252-5068 | 2018-10-11 |
| 1134257876 | Mel Bingham | Physician Assistant | 220 Bannock St, Malad City, ID 83252-5068 | 2007-03-02 |
| 1922026467 | Robert Todd Gillespie | Physician Assistant | 220 Bannock St, Suite B, Malad City, ID 83252-1256 | 2006-07-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821695792 | Chelsea Dylan Tennent | Physician Assistant | 1666 E Gentlewind St, Boise, ID 83706-5914 | 2020-10-05 |
| 1922615848 | Allison Cluff | Physician Assistant | 1320 Bennett Ave, Burley, ID 83318-2665 | 2020-09-24 |
| 1245846187 | Adam Baker | Physician Assistant | 271 Jefferson St, Blackfoot, ID 83221-1818 | 2020-09-16 |
| 1265045199 | Julia Claire Brodie | Physician Assistant | 2352 N Apple Ln, Pocatello, ID 83204-7231 | 2020-08-29 |
| 1326651035 | Jenna Marie Castillo | Physician Assistant | 150 Taft Ave, Pocatello, ID 83201-5140 | 2020-08-24 |
| 1174148696 | Colton Jason Randall | Physician Assistant | 3885 Orchard Cir, Ammon, ID 83406-4656 | 2020-06-10 |
| 1871114553 | Samantha Tess Goodrich | Physician Assistant | 721 E Lenz St, Boise, ID 83712-7846 | 2020-05-04 |
| 1174164305 | Tessie Mari Mcinnally | Physician Assistant | 3015 E Magic View Dr # 115, Meridian, ID 83642-3743 | 2019-09-29 |
| 1013562305 | Brianna Suzanne Berg | Physician Assistant | 12535 N Fawn Ct, Hayden, ID 83835-8827 | 2019-08-05 |
| 1003376559 | Kodie Thomas | Physician Assistant | 2086 Picket Ln, Emmett, ID 83617-9104 | 2019-03-21 |
| Find all providers with the same taxonomy | ||||
| City | MALAD CITY |
| Zip Code | 83252 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.