Monique R Clark, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

4704262087 Issued in MI

Practice address

20755 Greenfield Rd
Suite 100
Southfield, MI 48075-5403

Phone

(248) 557-0507

NPI assigned

Dec 13, 2016

Last updated

Dec 13, 2016By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• LTC Physician Care PC

  • Geriatric Medicine (Family Medicine) Physician
  • Bingham Farms, MI
  • NPI 1841991817
  Medicare reassignment NPD
• Quadir Jaleel MD PC

  • Internal Medicine Physician
  • Hamtramck, MI
  • NPI 1043342116
  Medicare reassignment NPD
• The Care Team-Primary Care Providers PLLC

  • Internal Medicine Physician
  • Farmington Hills, MI
  • NPI 1710699624
  Medicare reassignment NPD
• Premier Services of Michigan, LLC

  dba Community Medical Services

  • Methadone Clinic
  • Dearborn Heights, MI
  • NPI 1043507502
  NPD

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

{
    "created_epoch": "1481587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481587200000",
    "number": "1487198255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26520 MEADOWOOD CT N",
            "city": "LATHRUP VILLAGE",
            "state": "MI",
            "postal_code": "480764650",
            "telephone_number": "313-595-2218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20755 GREENFIELD RD",
            "address_2": "SUITE 100",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480755403",
            "telephone_number": "248-557-0507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "MONIQUE",
        "middle_name": "R",
        "name_prefix": "Ms.",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-12-13",
        "last_updated": "2016-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704262087",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• De'Zarae Clark
• Deonna Unique Clark
• Karen Noelle Clark, PHD
• Kiara Clark
• Lara Margaret Clark, D.D.S.
• Montana Clark
• Nariya Lynn Clark
• Nicole Clark
• Raynell Theresa Clark, M.A. CCC-SLP
• Tanya Marie Clark, J.D.

• Family Nurse Practitioner in Southfield, MI
• Providers in Southfield, MI by specialty
• Family Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.