Nickeisha Clarke, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY9310 Issued in FL

Practice address

4729 US 98 S
Suite 104
Lakeland, FL 33812-4323

Phone

(863) 877-1855

Fax

(863) 646-6111

NPI assigned

Aug 21, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Clarke Counseling and Psychological Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Brandon, FL
  • NPI 1063054310
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1534809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534809600000",
    "number": "1245710904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4729 US 98 S STE 104",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338124323",
            "telephone_number": "863-877-1855",
            "fax_number": "863-646-6111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4729 US 98 S",
            "address_2": "SUITE 104",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338124323",
            "telephone_number": "863-877-1855",
            "fax_number": "863-646-6111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARKE",
        "first_name": "NICKEISHA",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-21",
        "last_updated": "2018-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY9310",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Linda Clairmont, A.R.N.P.
• Valerie Ann Clanton
• Brandon Clark
• Gregory Clark
• Najda Clark
• Clarkes Hair Design
• Alejandro Claro Martin, RBT
• Quinton Aaron Clawson, LMHC, QS
• Gina Marie Claxton, MSW
• Isabel A Clayton, RN

• Clinical Psychologist in Lakeland, FL
• Providers in Lakeland, FL by specialty
• Clinical Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.