Provider Demographics
NPI:1053098038
Name:CLINGER, KLARISSA ANN
Entity type:Individual
Prefix:
First Name:KLARISSA
Middle Name:ANN
Last Name:CLINGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 E ELM ST
Mailing Address - Street 2:
Mailing Address - City:SHELLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83274-1314
Mailing Address - Country:US
Mailing Address - Phone:208-206-6063
Mailing Address - Fax:
Practice Address - Street 1:18 S 1ST E
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-1902
Practice Address - Country:US
Practice Address - Phone:208-656-4484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program