Angelique Clark

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

PN314105 Issued in PA

Practice address

159 Mayluth Rd
Johnstown, PA 15904-2632

Phone

(267) 240-9184

Fax

(267) 240-9184

NPI assigned

Apr 27, 2026

Last updated

Apr 27, 2026By 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 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• One Stick Diagnostic Services LLC

  • Clinical Medical Laboratory
  • Johnstown, PA
  • NPI 1639015233
  NPD Authorized official

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

{
    "created_epoch": "1777248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777248000000",
    "number": "1912843517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "159 MAYLUTH RD",
            "city": "JOHNSTOWN",
            "state": "PA",
            "postal_code": "159042632",
            "telephone_number": "267-240-9184",
            "fax_number": "267-240-9184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "159 MAYLUTH RD",
            "city": "JOHNSTOWN",
            "state": "PA",
            "postal_code": "159042632",
            "telephone_number": "267-240-9184",
            "fax_number": "267-240-9184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ANGELIQUE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-04-27",
        "last_updated": "2026-04-27",
        "certification_date": "2026-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "PA",
            "license": "PN314105",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Timothy R Chung, DO
• Sebastian J. Ciacchella, MD
• Alicia Joy Ciarimboli, RN
• Marc Joseph Clapper, D.O.
• Clarity Hearing Solutions LLC
• Jacob Asher Clark, MD
• Jill Anne Clark, BSW
• Michael Anthony Clark, M.S.W.
• Breton James Claycomb, M.E.
• David Scott Claycomb, RPH

• Licensed Practical Nurse in Johnstown, PA
• Providers in Johnstown, 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 27, 2026; 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.