Kimberley Amber Clark, FNP-C

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

APRN.CNP.024945 Issued in OH

Practice address

7629 Market St Ste 200
Youngstown, OH 44512-6082

Phone

(330) 965-4540

NPI assigned

Jul 1, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH, PA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Triad Health Services, LLC

  • Plastic Surgery Physician
  • Youngstown, OH
  • NPI 1588925457

  Nurse Practitioner

  Medicare reassignment NPD
• Quality Medical Associates, PC

  • Internal Medicine Physician
  • Butler, PA
  • NPI 1407316276
  Medicare reassignment NPD
• Southwoods Health at Home, LLC

  • Home Health Agency
  • Youngstown, OH
  • NPI 1023788940
  NPD (past)
• The Surgery Center at Southwoods, LLC

  • Special Hospital
  • Youngstown, OH
  • NPI 1740398890
  NPD (past)

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

{
    "created_epoch": "1561939200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561939200000",
    "number": "1043872864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "830 SCHENLEY AVE",
            "city": "NEW CASTLE",
            "state": "PA",
            "postal_code": "161015353",
            "telephone_number": "724-730-3212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7629 MARKET ST STE 200",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445126082",
            "telephone_number": "330-965-4540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KIMBERLEY",
        "middle_name": "AMBER",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-01",
        "last_updated": "2019-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OH",
            "license": "APRN.CNP.024945",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christian Clark
• Denise K Clark, MS, BCBA, COBA
• Evelyn C Clark, LPCC-S
• Frances Ann Clark, CNS
• Kanaija Clark
• Laquita M Clark, BSW
• Larry L Clark
• Noah C Clark, CMS, QMHS
• Tyniyah Clark
• Vonetta Marie Clark, B.S.

• Nurse Practitioner in Youngstown, OH
• Providers in Youngstown, OH by specialty
• Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.