Kamy Clark

Primary specialty

Adult Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0809X

License

95312417 Issued in CA

Practice address

855 3Rd Ave Ste 110
Chula Vista, CA 91911-1354

Phone

(619) 934-5770

NPI assigned

Dec 7, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1670371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687132800000",
    "number": "1013628338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "855 3RD AVE STE 110",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919111354",
            "telephone_number": "619-934-5770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "855 3RD AVE STE 110",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919111354",
            "telephone_number": "619-934-5770"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3835 Rosecrans St",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921019210",
            "country_code": "US",
            "telephone_number": "619-615-0439",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KAMY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-12-07",
        "last_updated": "2023-06-19",
        "certification_date": "2023-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "95312417",
            "primary": false
        },
        {
            "code": "163WP0809X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Adult",
            "state": "CA",
            "license": "95312417",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• City of Chula Vista
• Cky Pharmacy Inc
• Anna Clark
• Devin Clark
• John J Clark Jr., OD
• Keisha Clark
• William Edward Claude Jr., LCSW
• Candice Aquino Claudio, PT
• Edward A Claudio, PT
• Megan Clauson, LCSW

• Adult Psychiatric/Mental Health Registered Nurse in Chula Vista, CA
• Providers in Chula Vista, CA by specialty
• Adult Psychiatric/Mental Health Registered Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2023; 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.