Susan B Clark, MS, RD, LD, CDE

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

D-393 Issued in ID

Practice address

393 E 2ND N
Rexburg, ID 83440-1605

Phone

(208) 356-5401

NPI assigned

Aug 28, 2019

Last updated

Nov 24, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Madison Co Memorial Hospital

  dba Madison Memorial Rexburg Medical Clinic

  • Family Medicine Physician
  • Rexburg, ID
  • NPI 1134592017
  Medicare reassignment NPD
• Madison Co Memorial Hospital

  dba Rigby Medical Center

  • Family Medicine Physician
  • Rigby, ID
  • NPI 1356026280
  NPD
• Madison Co Memorial Hospital

  dba Madison Memorial Orthopedics

  • Orthopaedic Surgery Physician
  • Rexburg, ID
  • NPI 1730602756
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1566950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763942400000",
    "number": "1124676663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 E MAIN ST",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834402048",
            "telephone_number": "208-359-6522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "393 E 2ND N",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834401605",
            "telephone_number": "208-356-5401"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "450 E Main St",
            "address_purpose": "LOCATION",
            "city": "Rexburg",
            "state": "ID",
            "postal_code": "834402048",
            "country_code": "US",
            "telephone_number": "208-359-6522",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "SUSAN",
        "middle_name": "B",
        "credential": "MS, RD, LD, CDE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-28",
        "last_updated": "2025-11-24",
        "certification_date": "2025-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "ID",
            "license": "D-393",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Louie Cibrian
• Graciela Maria Clark, B.S.
• Jack O. Clark, M.D.
• Kimberly Clark
• Kohlee Clark
• Janell Clement, LCSW
• Zackery J Cleverley, PA-C
• Jeffery Michael Clift, MOT
• Klarissa Ann Clinger
• Melissa Clinger

• Registered Dietitian in Rexburg, ID
• Providers in Rexburg, ID by specialty
• Registered Dietitian in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.