Active NPI
Angela L Clarke, PN
- Licensed Practical Nurse
- Fort Hall, ID
National Provider Identifier
1073768669
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- PN 10202
- Practice address
- Pima Drive
Fort Hall, ID 83203-0306 - Phone
- (208) 238-2400
- Fax
- (208) 238-5462
- NPI assigned
- Nov 24, 2008
- Last updated
- Nov 24, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | PN 10202 | ID | Primary |
Addresses
Primary practice location
Pima Drive
Fort Hall, ID 83203-0306
Mailing address
PO Box 306
Fort Hall, ID 83203-0306
Phone (208) 238-2400
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 003399100 | Medicaid | ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Advanced Practice Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PN 10202 | ID | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1227484800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1227484800000",
"number": "1073768669",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 306",
"city": "FORT HALL",
"state": "ID",
"postal_code": "832030306",
"telephone_number": "208-238-2400",
"fax_number": "208-238-5462"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "PIMA DRIVE",
"city": "FORT HALL",
"state": "ID",
"postal_code": "832030306",
"telephone_number": "208-238-2400",
"fax_number": "208-238-5462"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARKE",
"first_name": "ANGELA",
"middle_name": "L",
"credential": "PN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-11-24",
"last_updated": "2008-11-24",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "ID",
"license": "PN 10202",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "003399100",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Hall, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.