Tymir Shakeer Clark

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

PN307634 Issued in PA

Practice address

2219 Edgley St
Philadelphia, PA 19121-1300

Phone

(267) 258-9167

NPI assigned

Apr 2, 2019

Last updated

Apr 2, 2019By the provider in NPPES

Sex

Male

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1554163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554163200000",
    "number": "1588126239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2219 EDGLEY ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191211300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2219 EDGLEY ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191211300",
            "telephone_number": "267-258-9167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "TYMIR",
        "middle_name": "SHAKEER",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-04-02",
        "last_updated": "2019-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "PA",
            "license": "PN307634",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tanner Mark Clark, D.M.D.
• Tenaya Clark, PA-C
• Tia Clark
• Tiffany Nicole Clark, M.D.
• Timothy William Ingraham Clark, MD
• Vicki Clark
• Zachary Robert Clark, PA-C
• Clarke Pennsylvania, Inc. (Clarke Schools for Hearing and Speech)
• Angela T Clarke, PH.D.
• Annemarie Frances Clarke, PH.D.

• Licensed Practical Nurse in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Licensed Practical Nurse in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2019; 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.