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NPI Code Detail

MEDICARE: MS. VICKI E CLARK NP

MEDICARE: MS. VICKI E CLARK NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LX0001XObstetrics & Gynecology Nurse Practitioner940105NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1609878800
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. VICKI E CLARK NP
Provider Business Mailing Address
First Line : 460 COUNTRY CLUB RD
Second Line :
City : LUMBERTON
State : NC
Zip : 28360-9494
Country : US
Telephone Number : 910-671-3200
Fax Number : 910-671-3484
Provider Business Practice Location Address
First Line : 460 COUNTRY CLUB RD
Second Line :
City : LUMBERTON
State : NC
Zip : 28360-9494
Country : US
Telephone Number : 910-671-3200
Fax Number : 910-671-3484
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2005
Last Update Date : 01/14/2025

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