Nicole Clark

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

RN313313 Issued in GA

Practice address

710 Center St
Columbus, GA 31901-1527

Phone

(706) 660-2952

NPI assigned

Nov 14, 2023

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

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": "1699920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699920000000",
    "number": "1588438113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4148 WILL RHOADES DR",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319093965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 CENTER ST",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319011527",
            "telephone_number": "706-660-2952"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "NICOLE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-11-14",
        "last_updated": "2023-11-14",
        "certification_date": "2023-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "GA",
            "license": "RN313313",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Holly D. Clark
• Jalita Lauren Clark, LPN
• Krystle Diane Clark, BCBA
• Linda Clark
• Meylon Tillman Clark
• Shirley Rushing Clark, R.PH.
• Tatum Michelle Clark, RBT
• Teri Clark, DO
• Zaliyah Clark
• Yolanda Clay

• Registered Nurse in Columbus, GA
• Providers in Columbus, GA by specialty
• Registered Nurse in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2023; 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.