Nicole Marie Clark, M.S. R.D.

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

1004345 Issued in NY

Practice address

2 Crescent Park West
Nutrition Services
Warren, PA 16365

Phone

(814) 723-4973

NPI assigned

Sep 23, 2009

Last updated

Sep 23, 2009By 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 2

Addresses

Other names 1

• Miss Nicole Marie Sorce Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1253664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1253664000000",
    "number": "1720312820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 CRESCENT PARK WEST",
            "address_2": "NUTRITION SERVICES",
            "city": "WARREN",
            "state": "PA",
            "postal_code": "16365",
            "telephone_number": "814-723-4973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 CRESCENT PARK WEST",
            "address_2": "NUTRITION SERVICES",
            "city": "WARREN",
            "state": "PA",
            "postal_code": "16365",
            "telephone_number": "814-723-4973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "NICOLE",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "M.S. R.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-23",
        "last_updated": "2009-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "132700000X",
            "taxonomy_group": "",
            "desc": "Dietary Manager",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NY",
            "license": "1004345",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "SORCE",
            "middle_name": "MARIE",
            "prefix": "MISS",
            "credential": "M.S. R.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Children's Center for Treatment and Education (Beacon Light Behavioral Health System)
• Children's Center for Treatment and Education (Beacon Light Behavioral Health System)
• Shelby Chimiak, CRNP
• Megan Sue Church, DO
• City of Warren
• Edwina Clarke, MD
• Beverly Ann Clever, COTA
• Frank David Clifford, MD
• Clinical Therapeutics Inc (CTI Physical Therapy)
• Community Anesthesia Services, LLC

• Registered Dietitian in Warren, PA
• Providers in Warren, PA by specialty
• Registered Dietitian in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2009; 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.