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Individual

MR. JEREMIAH ROBINS CLARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
FNP-BC

Contact information

Practice address
1526 W USTICK RD STE 110, MERIDIAN, ID 83646-7741
(208) 370-5888
(206) 717-7104
Mailing address
8838 W PINE VALLEY LN, BOISE, ID 83709-0025
(269) 428-7228

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
TEMP77813
ID
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
77813
ID

Other

Enumeration date
10/20/2023
Last updated
06/23/2025
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