Kelly Anne Clark

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

075351 Issued in NY

Practice address

1715 Castle Gardens Rd
Vestal, NY 13850-1175

Phone

(607) 341-7017

NPI assigned

Nov 26, 2018

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

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• Our Lady of Lourdes Memorial Hospital Inc.

  • General Acute Care Hospital
  • Binghamton, NY
  • NPI 1629087580
  Medicare reassignment NPD
• Our Lady of Lourdes Memorial Hospital, Inc.

  • Specialty Pharmacy
  • Johnson City, NY
  • NPI 1730982596
  NPD
• Twin Tier Pathology Associates, PC

  • Clinical Pathology/Laboratory Medicine Physician
  • Binghamton, NY
  • NPI 1770577470
  NPD

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

{
    "created_epoch": "1543190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543190400000",
    "number": "1073083788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "93 PARK AVE",
            "city": "BINGHAMTON",
            "state": "NY",
            "postal_code": "139033226",
            "telephone_number": "607-321-5179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1715 CASTLE GARDENS RD",
            "city": "VESTAL",
            "state": "NY",
            "postal_code": "138501175",
            "telephone_number": "607-341-7017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KELLY",
        "middle_name": "ANNE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-11-26",
        "last_updated": "2018-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "075351",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vidhi Chokshi, NP
• Jessica Cholko, PA
• Michele Ann Chou, M.A., CCC-SLP
• Michael Albert Christensen, OD
• Citizen Medical Care PLLC
• Clintwood Health and Wellness
• Leslie Cody, OTR/L
• Elizabeth Rose Collins, LPN
• Megan E Collins, DPT
• Ryan T. Comfort

• Clinical Social Worker in Vestal, NY
• Providers in Vestal, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2018; 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.