MEDICARE: MS. NIKILIA CLARK I

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
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1619331790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NIKILIA CLARK I

Provider Business Mailing Address
First Line	:	4069 BARNES AVE # LL
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-4328
Country	:	US
Telephone Number	:	646-702-6965
Fax Number	:

Provider Business Practice Location Address
First Line	:	4069 BARNES AVE # LL
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-4328
Country	:	US
Telephone Number	:	646-702-6965
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2016
Last Update Date	:	04/05/2016

Similar Medicare Providers

1760696819 — MS. SHARIFA J ARMORER LCSW-R
Practice Location Address:

4067 BARNES AVE , SUITE 1
BRONX, NY
10466-4328

Practice Phone: 914-384-3905
Practice Fax:

1740514165 — UNIVERSAL HEALTHCARE SYSTEM LLC
Practice Location Address:

4328 MATILDA AVE
BRONX, NY
10466-1315

Practice Phone: 917-557-4477
Practice Fax:

1528375383 — MISS KAYTANA M JOHNSON RN
Practice Location Address:

4328 MATILDA AVE
BRONX, NY
10466-1315

Practice Phone: 914-564-0639
Practice Fax:

1740560994 — ANN ASHLEY LPN
Practice Location Address:

4328 MATILDA AVE
BRONX, NY
10466-1315

Practice Phone: 718-671-2100
Practice Fax:

1699146258 — MS. SELENA GIBBONS
Practice Location Address:

4069 BARNES AVE , LL
BRONX, NY
10466-4328

Practice Phone: 646-702-6965
Practice Fax: 914-462-4513

1396296802 — MRS. BEVERLY JEAN NASH RN
Practice Location Address:

4328 DEREIMER AVE.
BRONX, NY
10466-1820

Practice Phone: 347-346-9759
Practice Fax:

Directions to “ MS. NIKILIA CLARK I ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.