Individual
MACEY CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP-C, AGNP-C
Contact information
Practice address
710 SUNSET DR, SUITE E, LA GRANDE, OR 97850-1200
(541) 962-5600
Mailing address
PO BOX 3290, LA GRANDE, OR 97850-7290
(541) 963-1967
(541) 963-1837
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
201704371NP-PP
OR
363LG0600X
Gerontology Nurse Practitioner
201704371NP-PP
OR
Other
Enumeration date
05/10/2017
Last updated
05/29/2025
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