| Doctor Name: | NATHANIEL CLARK |
| NPI Number: | 1063660074 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | P.A. |
| License Number: | 085003278 |
| Business Practice Address: | 409 W Oak St Carbondale, IL - 629011414 |
| Business Phone Number: | 6185294455 |
| Business Fax Number: | 6183511287 |
| Mailing Address: | Po Box 1105, INDIANAPOLIS |
| State: | IN |
| Postal Code: | 462061105 |
| Phone Number: | 6185294455 |
| Fax Number: | 6183511287 |
| NPI Enumeration Date: | 09/03/2008 |
| NPI Last Update Date: | 02/14/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 085003278 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |