STEPHANIE CLARK NP
NPI 1912288572
Nurse Practitioner in Pocatello, ID

Q: What is Stephanie Clark's NPI number?

The NPI number for Stephanie Clark is 1912288572. It was assigned to this individual provider in the NPPES registry on September 8, 2011.

Q: What is Stephanie Clark's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Q: Is Stephanie Clark enrolled in Medicare?

No. Stephanie Clark has opted out of Medicare through January 1, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

Q: When was this NPI record last updated?

The NPPES record for Stephanie Clark was last updated on September 21, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since September 08, 2011Opted out of Medicare · through Jan 1, 2027

1951 BENCH ROAD, STE A, POCATELLO, ID 83201(208) 549-7385(208) 216-6761 Get Directions Write a Review

NPPES record last updated: September 21, 2023. Verified against the NPPES registry weekly; last sync: September 06, 2026.

On this page

About Stephanie Clark Np NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

STEPHANIE CLARK NP (NPI 1912288572) is an individual nurse practitioner in Pocatello, Idaho, licensed in Idaho (NP-1100A) and active in the NPI registry since September 2011. She has opted out of Medicare through January 1, 2027.

NPPES Registry Identity

NPI1912288572

Entity TypeIndividualFemale

Primary Taxonomy363L00000X

Provider Legal NameSTEPHANIE CLARKCredential: NP

Location Address1951 BENCH ROAD, STE APocatello, ID 83201-2073

Mailing Address1951 Bench Road, Ste APocatello, ID 83201-2073 · (208) 549-7385 · Fax (208) 216-6761

Phone(208) 549-7385

Fax(208) 216-6761

Sole ProprietorYes

Enumeration DateSeptember 8, 2011

Last NPPES UpdateSeptember 21, 2023

✔ NPI 1912288572 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363L00000X

License✔ Licensed in ID · NP-1100A

Definition

(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

Also ListedRegistered NurseTaxonomy 163W00000X · License N-35468 (ID)

1951 BENCH ROAD, Pocatello, ID 83201

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include PacificSource Health Plans, Providence Health Plan.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

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Opted out of Medicare

Stephanie Clark Np has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from January 1, 2025 through January 1, 2027.

Opt-Out Effective DateJanuary 1, 2025

Opt-Out In Effect ThroughJanuary 1, 2027Opt-out affidavits renew automatically every two years unless cancelled

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Stephanie Clark's NPI number?

The NPI number for Stephanie Clark is 1912288572. It was assigned to this individual provider in the NPPES registry on September 8, 2011.

Where is Stephanie Clark located?

Stephanie Clark practices at 1951 Bench Road Ste A, Pocatello, ID 83201. The listed phone number is (208) 549-7385.

What is Stephanie Clark's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Is Stephanie Clark enrolled in Medicare?

No. Stephanie Clark has opted out of Medicare through January 1, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

What insurance does Stephanie Clark accept?

Health plans from PacificSource Health Plans and Providence Health Plan list Stephanie Clark as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Stephanie Clark was last updated on September 21, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.