MEDICARE: BEYONKA CLARK

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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1932715992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEYONKA CLARK

Provider Business Mailing Address
First Line	:	4384 SOUTHERN AVE SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20019-5633
Country	:	US
Telephone Number	:	240-300-6006
Fax Number	:

Provider Business Practice Location Address
First Line	:	4800 NANNIE HELEN BURROUGHS AVE NE APT 507
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20019-3772
Country	:	US
Telephone Number	:	202-413-8330
Fax Number	:

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

Provider Enumeration Date	:	09/16/2020
Last Update Date	:	09/16/2020

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Directions to “ BEYONKA CLARK ” Practice Location

Language	Start Address	Practice Location

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