Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mary Ellen Clark, CFNP

Individual provider Family Nurse Practitioner · NPI 1891031621

Mary Ellen Clark, CFNP is a Nurse Practitioner in Warren, Indiana. Qualified in 2012, 14 years ago. Works from 2 locations and accepts Medicare assignment. Licensed in Idaho, Indiana, New Mexico and Oregon.

Years since qualifying
14
Licensed in
ID, IN, NM, OR
In the registry since
2012
Specialties on file
4

Practice location Address checks out

824 Huntington Ave
Warren, IN 46792-9277
Phone: (260) 375-2965
Fax: (260) 375-2969
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 90 Hope Dr Bldg 6000, Mountain Home Afb, ID 83648-1062 — (208) 828-7635

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 71016668A (IN)
Family Nurse Practitioner Taxonomy 363LF0000X · Licence CNP-02460 (NM)
Primary Care Nurse Practitioner Taxonomy 363LP2300X · Licence 66049 (ID)
Family Nurse Practitioner Taxonomy 363LF0000X · Licence 201250210NP (OR)

Record details

NPI number1891031621
Entity typeIndividual (Type 1)
GenderFemale
Credentials CFNP
Sole proprietorNo
NPI enumeratedDecember 26, 2012
Last updated in NPPESOctober 7, 2025
Certification dateOctober 7, 2025
Mailing address240 N Tillotson Ave, Muncie, IN 47304-3988

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2012 (14 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Warren