Latisa Clark, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

L2-0012231 Issued in DE

Practice address

769 E Masten Cir Ste 113
Milford, DE 19963-1268

Phone

(302) 856-4700

NPI assigned

May 14, 2018

Last updated

May 14, 2018By the provider in NPPES

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

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

• Brandywine Counseling & Community Services, Inc.

  • Adult Mental Health Clinic/Center
  • Wilmington, DE
  • NPI 1346320983
  NPD (past)

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

{
    "created_epoch": "1526256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526256000000",
    "number": "1295225431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "769 E MASTEN CIR STE 113",
            "city": "MILFORD",
            "state": "DE",
            "postal_code": "199631268",
            "telephone_number": "302-856-4700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "769 E MASTEN CIR STE 113",
            "city": "MILFORD",
            "state": "DE",
            "postal_code": "199631268",
            "telephone_number": "302-856-4700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "LATISA",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-14",
        "last_updated": "2018-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "DE",
            "license": "L2-0012231",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Children and Families First
• Choice Pain & Rehabilitation Center
• Christiana Care Home Health and Community Services Inc (Christiana Care Visiting Nurse Association)
• Kimberly Christie
• Brandi Ciamarra
• David J Cloney, M.D.
• Cnmri 20 PA
• Cnmri PA
• Coastal Orthopaedics, P.a.
• Taylor Coco, AGNP

• Licensed Practical Nurse in Milford, DE
• Providers in Milford, DE by specialty
• Licensed Practical Nurse in Delaware

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 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.