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Hailey A. Clark FNP-C LLC

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Company Details

Name: Hailey A. Clark FNP-C LLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Inactive-Dissolved (Administrative)
Date of registration: 08 Dec 2020 (5 years ago)
Financial Date End: 31 Dec 2022
Date dissolved: 21 Mar 2023
Entity Number: 4094883
Place of Formation: IDAHO
File Number: 736901
ZIP code: 83401
County: Bonneville County
Principal Address: 4060 DUANE ST IDAHO FALLS, ID 83401-1846
Mailing Address: 9355 OUTLAW PASS MENAN, ID 83434-5209

Agent

Name Role Address
Hailey A Clark Agent 9355 OUTLAW PASS, MENAN, ID 83434

Manager

Name Role Address Appointed On
Hailey A Clark Manager 9355 OUTLAW PASS, MENAN, ID 83434 2022-01-18

National Provider Identifier

NPI Number:
1689269177
Certification Date:
2021-03-05

Authorized Person:

Name:
MRS. HAILEY ANNE CLARK
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
261QH0100X - Health Service Clinic/Center
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Dissolution/Revocation - Administrative 0005161820 2023-03-21
Annual Report 0004574761 2022-01-18
Initial Filing 0004094883 2020-12-08

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Date of last update: 18 May 2025

Sources: Idaho Secretary of State