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NPI Code Detail

MEDICARE: CECELIA CLARKE NP-C, MD

MEDICARE:   CECELIA  CLARKE  NP-C, MD
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
1363LF0000XFamily Nurse Practitioner0024166730VA

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 : 1023097615
Entity Type Code : Individual
Provider Name (Legal Business Name) : CECELIA CLARKE NP-C, MD
Provider Business Mailing Address
First Line : 320 GRANDVILLE ARCH
Second Line :
City : SMITHFIELD
State : VA
Zip : 23430-6266
Country : US
Telephone Number : 757-332-6342
Fax Number :
Provider Business Practice Location Address
First Line : 1820 E WARM SPRINGS RD STE 140
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-4593
Country : US
Telephone Number : 702-779-3956
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/11/2006
Last Update Date : 01/31/2024

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