Chanel Clark, RDN, LD is a
Dietitian, Registered based in Indian Valley, Idaho. Chanel Clark is licensed to practice in Idaho (license number D-859) and her current practice location is
2278 Moritz Ln, Indian Valley, Idaho. She can be reached at her office (for appointments etc.) via phone at
(208) 816-8365.
NPI number for Chanel Clark is 1609424183 and her current mailing address is 2278 Moritz Ln, Indian Valley, Idaho. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1609424183.
Healthcare Provider's Profile
Full Name | Chanel Clark |
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Gender | Female |
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Speciality | Dietitian, Registered |
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Location | 2278 Moritz Ln, Indian Valley, Idaho |
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Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
NPI Data:
- NPI Number: 1609424183
- Provider Enumeration Date: 08/28/2019
- Last Update Date: 08/28/2019
Medical Identifiers
Medical identifiers for Chanel Clark such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1609424183 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
133V00000X | Dietitian, Registered | D-859 (Idaho) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Chanel Clark is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Chanel Clark, RDN, LD 2278 Moritz Ln, Indian Valley, ID 83632-5019 Ph: () - | Chanel Clark, RDN, LD 2278 Moritz Ln, Indian Valley, ID 83632-5019 Ph: (208) 816-8365 |
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