Active NPI
Telisha Niketia Clark
- Family Nurse Practitioner
- Fayetteville, GA
National Provider Identifier
1659281608
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- APRN-NP312405
- Practice address
- 475 Hilo Rd
Fayetteville, GA 30215-2101 - Phone
- (678) 778-1224
- NPI assigned
- Sep 10, 2026
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | APRN-NP312405 | GA | Primary |
Addresses
Primary practice location
475 Hilo Rd
Fayetteville, GA 30215-2101
Mailing address
475 Hilo Rd
Fayetteville, GA 30215-2101
Phone (678) 778-1224
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1788998400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1788998400000",
"number": "1659281608",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "475 HILO RD",
"city": "FAYETTEVILLE",
"state": "GA",
"postal_code": "302152101",
"telephone_number": "678-778-1224"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "475 HILO RD",
"city": "FAYETTEVILLE",
"state": "GA",
"postal_code": "302152101",
"telephone_number": "678-778-1224"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "TELISHA",
"middle_name": "NIKETIA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2026-09-10",
"last_updated": "2026-09-10",
"certification_date": "2026-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Nurse Practitioner, Family",
"state": "GA",
"license": "APRN-NP312405",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.