Illise Clark, FNP-NP
NPI 1396004776ActiveIndividual· Nurse Practitioner, Family· Mentor, OH
Nurse Practitioner, Family (FNP-NP) in Mentor, Ohio, licensed in OH, with an NPI issued in May 2012. Enrolled in Medicare as practitioner - nurse practitioner.
Overview
| NPI | 1396004776 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | FNP-NP |
| Sole proprietor | No |
| NPI issued | May 7, 2012 |
| Last updated in NPPES | May 12, 2026 |
| Certified by provider | May 12, 2026 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Nurse Practitioner, Family Primary | 363LF0000X | APRN.CNP.0022454 | OH |
| Registered Nurse | 163W00000X | RN.371331 | OH |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Nurse Practitioner (OH) |
|---|
Industry payments (Open Payments)
None reported for 2025 or 2024.
Receiving payments does not imply wrongdoing. What Open Payments covers ·original records
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