Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Victoria Dene Clark

Individual provider Adult Health Nurse Practitioner · NPI 1417361502

Victoria Dene Clark is a Nurse Practitioner in Southfield, Michigan. Qualified in 2013, 13 years ago. Practices with Ltc Physician Care PC, a 17-clinician group and accepts Medicare assignment. Licensed in Michigan.

Years since qualifying
13
Licensed in
MI
In the registry since
2014
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Practice location Address checks out

24111 Southfield Rd
Southfield, MI 48075-2841
Phone: (248) 557-8800
Fax: (248) 557-8860
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Adult Health Nurse Practitioner (primary) Taxonomy 363LA2200X · Licence 4704276153 (MI)

Record details

NPI number1417361502
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedJune 17, 2014
Last updated in NPPESNovember 20, 2014

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2013 (13 years in practice)
Group practice Ltc Physician Care Pc — 17 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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