Alisha Clark
Individual provider Active NPI Driver · Indianapolis, IN
NPI 1104477546 · NPPES record last updated Sep 26, 2019
Key facts
- NPI
- 1104477546
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Driver 172A00000X
- Practice address
- 3907 Elmonte CT
Indianapolis, IN 46226-5536 - Phone
- (602) 814-7212
- NPI assigned
- Sep 26, 2019
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | IN | Yes |
Addresses
Primary practice location
3907 Elmonte CT
Indianapolis, IN 46226-5536
Mailing address
3907 Elmonte CT
Indianapolis, IN 46226-5536
Phone (602) 814-7212
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 843176537 | Medicaid | IN |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | alisha.m.clark@store.lowes.com |
Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 26, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.