Provider Demographics
NPI:1962487587
Name:CLARK, HILARY E (PA-C)
Entity Type:Individual
Prefix:
First Name:HILARY
Middle Name:E
Last Name:CLARK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 TELLURIDE ST UNIT 5
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-4356
Mailing Address - Country:US
Mailing Address - Phone:303-396-5923
Mailing Address - Fax:303-957-5414
Practice Address - Street 1:191 TELLURIDE ST UNIT 5
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-4356
Practice Address - Country:US
Practice Address - Phone:033-396-5923
Practice Address - Fax:033-957-5414
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0001492363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P53777Medicare UPIN
CO448096YLL6Medicare PIN