MR. JOHN RILEY CLARK PA-C NPI 1063072973

NPI Information

  • NPI: 1063072973
  • Provider Name: MR. JOHN RILEY CLARK, PA-C
  • Classification: Physician Assistant - 363AM0700X
  • Specialization: Medical
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 2700 LIGHT RD APT 102
    OSWEGO, IL
    ZIP 60543
  • Phone: (415) 516-8668

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NPI Details

MR. John Riley Clark, PA-C is a medical physician assistant in Oswego, IL. MR. John Riley Clark, PA-C NPI is 1063072973. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

2700 LIGHT RD APT 102
OSWEGO, IL
ZIP 60543-231
Phone: (415) 516-8668

The NPI 1063072973 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Power Mobility Devices.

The enumeration date for this NPI number is 6/13/2019 and was last updated on 8/2/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363AM0700XPhysician AssistantMedical085.007136ILLINOISYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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