Marie Clark, NREMT
Individual provider Active NPI Basic Emergency Medical Technician · Atlanta, ID
NPI 1164306809 · NPPES record last updated Aug 5, 2025
Key facts
- NPI
- 1164306809
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Basic Emergency Medical Technician 146N00000X
- License
- 8342-4482-1318 (ID)
- Practice address
- 97 W Pine St
Atlanta, ID 83716-5032 - Phone
- (206) 396-7437
- NPI assigned
- Aug 5, 2025
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8342-4482-1318 | ID | MD | Basic Emergency Medical Technician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Basic Emergency Medical Technician | 146N00000X | 8342-4482-1318 | ID | Yes |
Addresses
Primary practice location
97 W Pine St
Atlanta, ID 83716-5032
Mailing address
65 W China Basin Rd
Atlanta, ID 83716-5024
Phone (206) 396-7437
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 5, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.