Provider Demographics
NPI:1063852572
Name:CLARK, CANDICE PIKE (NP)
Entity type:Individual
Prefix:MS
First Name:CANDICE
Middle Name:PIKE
Last Name:CLARK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:THELESIA
Other - Last Name:PIKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2000 PERIMETER PARK DR
Mailing Address - Street 2:STE 200
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-8442
Mailing Address - Country:US
Mailing Address - Phone:984-215-4110
Mailing Address - Fax:
Practice Address - Street 1:6013 FARRINGTON RD STE 101
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-8173
Practice Address - Country:US
Practice Address - Phone:984-974-7010
Practice Address - Fax:984-974-7020
Is Sole Proprietor?:No
Enumeration Date:2013-06-28
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5006255363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCD726AMedicare PIN