Kelly L Clark, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

2010 Issued in AR

Practice address

1500 Museum Rd Ste 104
Conway, AR 72032-4761

Phone

(501) 329-3804

Fax

(501) 329-0718

NPI assigned

Sep 16, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Miss Kelly L Wood Former name

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": "1158364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1053417907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 MUSEUM RD STE 104",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720324761",
            "telephone_number": "501-329-3804",
            "fax_number": "501-329-0718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 MUSEUM RD STE 104",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720324761",
            "telephone_number": "501-329-3804",
            "fax_number": "501-329-0718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KELLY",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "AR",
            "license": "2010",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTA LICENSE",
            "identifier": "2010",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "WOOD",
            "middle_name": "L",
            "prefix": "MISS",
            "credential": "PTA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Edgel Clark, RECOVERY ASSISTANT
• Emmett Don Clark Jr., PTA
• James T Clark Jr., M.D.
• Jaymond Ryan Clark, DC
• John Nicholas Clark, D.D.S.
• Leslea Clark, M.S.CCC-SLP
• Mark L Clark, PHD
• Raymond H Clark, MD
• Sarah Grace Clark, DDS
• Candace Marie Clarke-Brown, AT

• Physical Therapy Assistant in Conway, AR
• Providers in Conway, AR by specialty
• Physical Therapy Assistant in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.