Individual
CLARK JOSEPH WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP-C
Contact information
Practice address
1502 LOCUST ST N STE 600, TWIN FALLS, ID 83301-4164
(208) 734-6091
(208) 734-4654
Mailing address
1131 COLE ST, KIMBERLY, ID 83341-5138
(208) 490-1901
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
57139
ID
Other
Enumeration date
10/17/2017
Last updated
11/17/2020
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