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General NPI Number Information
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NPI Number | 1083300727
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Entity Type | Individual
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Provider Name | DEVIAN CLARKE
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Gender | Male
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Dates
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Enumeration Date | 04/14/2023
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Last Update Date | 08/13/2026
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Provider Practice Location Address
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Address Line | 11783 BRUSH HOLLOW LN
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City | VICTORVILLE
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State | CA
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Zip | 92392-5711
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Country | US
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Telephone | 909-553-3713
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Fax |
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Provider Business Mailing Address
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Address Line | 11783 BRUSH HOLLOW LN
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City | VICTORVILLE
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State | CA
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Zip | 92392-5711
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 2026023000
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 95335693
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | 287721
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License Number State | CA
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