Individual
JULIE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
10255 OVERLAND RD, BOISE, ID 83709-1430
(208) 302-5600
(208) 302-5655
Mailing address
3340 E GOLDSTONE WAY, MERIDIAN, ID 83642
(208) 302-5600
(208) 302-5655
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA256
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
805414100
—
ID
Enumeration date
06/15/2006
Last updated
11/17/2016
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