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

Nathaniel Clark, PA

Individual provider Interventional Cardiology Physician · NPI 1063660074

Nathaniel Clark, PA is a Physician Assistant in Carbondale, Illinois. Qualified in 2008, 18 years ago. Practices with Deaconess Illinois Specialty Clinic, Inc, a 139-clinician group, works from 4 locations and accepts Medicare assignment. Licensed in Illinois.

Years since qualifying
18
Licensed in
IL
In the registry since
2008
Specialties on file
2
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

See every abbreviation used in this directory →

Practice location Address checks out

409 W Oak St
Carbondale, IL 62901-1464
Phone: (618) 529-4455
Fax: (618) 351-1287
Show map & directions

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

Additional practice locations (3)

  • 100 Dr Warren Tuttle Dr, Harrisburg, IL 62946-2718 — (618) 529-4455
  • 217 S Park Ave Ste 2, Herrin, IL 62948-3611 — (618) 529-4455
  • 3905 W Ernestine Dr, Marion, IL 62959-5800 — (618) 529-4455

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 085003278 (IL)
Interventional Cardiology Physician Taxonomy 207RI0011X · Licence 085-003278 (IL)

Record details

NPI number1063660074
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedSeptember 3, 2008
Last updated in NPPESDecember 21, 2022
Certification dateDecember 21, 2022
Mailing address409 W Oak St, Carbondale, IL 62901-1464

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2008 (18 years in practice)
Group practice Deaconess Illinois Specialty Clinic, Inc. — 139 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

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