Provider Demographics
NPI:1578941738
Name:CLARK, MIESHIA STAPLES (DNP)
Entity Type:Individual
Prefix:MRS
First Name:MIESHIA
Middle Name:STAPLES
Last Name:CLARK
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 CARLTON LANE
Mailing Address - Street 2:SUITE B
Mailing Address - City:REHOBOTH
Mailing Address - State:DE
Mailing Address - Zip Code:19971
Mailing Address - Country:US
Mailing Address - Phone:770-314-2611
Mailing Address - Fax:
Practice Address - Street 1:18766 JOHN J WILLIAMS HWY STE 306
Practice Address - Street 2:
Practice Address - City:REHOBOTH BEACH
Practice Address - State:DE
Practice Address - Zip Code:19971-4417
Practice Address - Country:US
Practice Address - Phone:302-985-2520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-08
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN002575363L00000X
GARN209521363LF0000X
DELG-0001366363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1578941738Medicaid