Provider Demographics
NPI:1619331790
Name:CLARK, NIKILIA I
Entity Type:Individual
Prefix:MS
First Name:NIKILIA
Middle Name:
Last Name:CLARK
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4069 BARNES AVE # LL
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-4328
Mailing Address - Country:US
Mailing Address - Phone:646-702-6965
Mailing Address - Fax:
Practice Address - Street 1:4069 BARNES AVE # LL
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-4328
Practice Address - Country:US
Practice Address - Phone:646-702-6965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program