Provider Demographics
NPI:1912405291
Name:CLARK, ALLISON KAYE (PMHNP-BC DNP)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:KAYE
Last Name:CLARK
Suffix:
Gender:F
Credentials:PMHNP-BC DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1270 AVENUE OF THE AMERICAS STE 757
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10020-1700
Mailing Address - Country:US
Mailing Address - Phone:646-248-7651
Mailing Address - Fax:646-871-6827
Practice Address - Street 1:1270 AVENUE OF THE AMERICAS STE 757
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10020-1700
Practice Address - Country:US
Practice Address - Phone:646-248-7651
Practice Address - Fax:646-871-6827
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-01
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY402344363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health