NPI age
11 years
Enumerated 2014-09-15
● Active
Type 1 · Individual
Charlene Clark, FNP
Clark is 1 of 9 nurse practitioner providers in Mountain Home and 1 of 1280 in Idaho.
Primary specialty
Nurse Practitioner
Plus 2 subspecialties
Licensed in
WA, ID, TN
3 states
Status
Active
No deactivations on record
Last NPPES update
2025-01-08
Source: monthly bulk 2026-05
Sole proprietor
No
May be part of a larger org
How this provider compares
Across 1280 active nurse practitioner providers in Idaho.
NPI age
11 years
↑ 4 yr above median (7 yr)
State licenses
3 states
Top 86% — 13% of peers are multi-state
Subspecialties
0
27% of peers hold subspecialties
NPI lifetime · 2014 → 2026
2014-09Enumerated in NPPES
2014
2026
Where they practice
Practice location
120 Desert Sage Way
Mountain Home, ID 836471038
Mailing address
1205 Teton Ave
Caldwell, ID 836052553
Specialties
-
Nurse Practitioner PrimaryDefinition to come...
Identifiers
| Type | Value | Notes |
|---|---|---|
| 01 (TN) | 19070 | APN LICENSE |
Multi-state credentialing: Licensed in 3 states. Useful context for credentialers building cross-state provider networks.
Practice context
Part of a multi-provider practice. 19 other active providers share this practice address in NPPES.
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Request a quote →How to verify this provider
- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
- Check the state license is currently active.State licensing boards publish current status; NPPES does not.
- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.