{"npi":"1043671696","type":"NPI-1","status":"active","name":{"display":"Nikki Clark FNP-Bc","other":[{"code":"1","type":"Formerly known as","value":"JESSUP, NIKKI C"}],"first":"NIKKI","last":"CLARK","middle":"J","credential":"FNP-BC"},"specialty":{"primary_taxonomy":"363LF0000X","primary_taxonomy_description":"Family Nurse Practitioner","slug":"family-nurse-practitioner","schema_org_specialty":null,"all":[{"code":"363LF0000X","description":"Family Nurse Practitioner","primary":true,"state":"TX","license":"1180324"},{"code":"363L00000X","description":"Nurse Practitioner","primary":false,"state":"MS","license":"893588"},{"code":"363LF0000X","description":"Family Nurse Practitioner","primary":false,"state":"MS","license":"893588"}]},"addresses":[{"purpose":"LOCATION","street_1":"3520 NW CENTRE DR","city":"LAKE WORTH","state":"TX","postal_code":"761353612","country_code":"US","phone":"7013644999"},{"purpose":"MAILING","street_1":"3520 NW CENTRE DR","city":"LAKE WORTH","state":"TX","postal_code":"761353612","country_code":"US","phone":"7013644999"}],"license":{"state":"TX","number":"1180324"},"identifiers":[{"type_code":"05","label":"Medicaid","value":"1484259","state":"ND","issuer":null},{"type_code":"05","label":"Medicaid","value":"05436046","state":"MS","issuer":null}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"I20160412000544","type_code":"14-50","type_desc":"PRACTITIONER - NURSE PRACTITIONER","state":"MS","pac_id":"7911205711"},{"enrlmt_id":"I20250303003318","type_code":"14-50","type_desc":"PRACTITIONER - NURSE PRACTITIONER","state":"TX","pac_id":"7911205711"}]},"enumeration_date":"2016-03-10","last_updated":"2026-03-04","_meta":{"source":"NPPES","snapshot_date":"2026-03-04","doc_url":"https://findmynpi.com/api"}}