Mary Kay Klockmann, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

RN402384 Issued in CA

Practice address

608 G Street
Brawley
Brawley, CA 92227-2567

Phone

(760) 351-1011

Fax

(760) 545-0247

NPI assigned

Jul 11, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/CBHJAA
• FHIR API: https://fhir4.healow.com/fhir/r4/IHGEDD/Endpoint/IHGEDD

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Deen Enterprises Medical Corporation

  • Cardiovascular Disease Physician
  • El Centro, CA
  • NPI 1336912294
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588896000000",
    "number": "1003840174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "516 W ATEN RD",
            "address_2": "IMPERIAL",
            "city": "IMPERIAL",
            "state": "CA",
            "postal_code": "922519805",
            "telephone_number": "760-355-7730",
            "fax_number": "760-355-7731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "608 G STREET",
            "address_2": "BRAWLEY",
            "city": "BRAWLEY",
            "state": "CA",
            "postal_code": "922272567",
            "telephone_number": "760-351-1011",
            "fax_number": "760-545-0247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLOCKMANN",
        "first_name": "MARY KAY",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-11",
        "last_updated": "2020-05-08",
        "certification_date": "2020-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364SF0001X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Family Health",
            "state": "CA",
            "license": "9766NP",
            "primary": false
        },
        {
            "code": "364SF0001X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Family Health",
            "state": "CA",
            "license": "402384RN",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "RN402384",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dan Ward Kang
• Fakhruddin S Kapadia, MD
• Devendra S Kapoor, MD
• Kestutis V. Kuraitis, M.D., PH.D., Inc.
• Saima Khan, MD
• Michael Krutzik, MD
• Brent Timothy Kunzler, PA
• Kestutis V Kuraitis, MD
• La Suarez a Professional Corporation
• Christopher C Lai, MD

• Nurse Practitioner in Brawley, CA
• Providers in Brawley, CA by specialty
• Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.