Provider Demographics
NPI:1326638537
Name:CLARK, HALLIE J (NP)
Entity Type:Individual
Prefix:
First Name:HALLIE
Middle Name:J
Last Name:CLARK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:HALLIE
Other - Middle Name:J
Other - Last Name:SPURGEON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1510
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47706-1510
Mailing Address - Country:US
Mailing Address - Phone:812-450-6815
Mailing Address - Fax:812-450-6822
Practice Address - Street 1:1204 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:OAKLAND CITY
Practice Address - State:IN
Practice Address - Zip Code:47660-1001
Practice Address - Country:US
Practice Address - Phone:812-749-6187
Practice Address - Fax:812-749-4966
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28198172A363L00000X
IN71010836A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner