Kelly Anne Clark, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

APRN.CNP.0036958 Issued in OH

Practice address

7916 Carraway CT
Maineville, OH 45039-8994

Phone

(513) 505-0588

NPI assigned

Jul 8, 2024

Last updated

Jul 8, 2024By the provider in NPPES

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Mkeac LLC

  • Family Nurse Practitioner
  • Maineville, OH
  • NPI 1790662914

  Psychiatric/Mental Health

  NPD

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

{
    "created_epoch": "1720396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720396800000",
    "number": "1083450084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7916 CARRAWAY CT",
            "city": "MAINEVILLE",
            "state": "OH",
            "postal_code": "450398994",
            "telephone_number": "513-505-0588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7916 CARRAWAY CT",
            "city": "MAINEVILLE",
            "state": "OH",
            "postal_code": "450398994",
            "telephone_number": "513-505-0588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KELLY",
        "middle_name": "ANNE",
        "credential": "PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-07-08",
        "last_updated": "2024-07-08",
        "certification_date": "2024-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OH",
            "license": "APRN.CNP.0036958",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Lavon-Renee Campbell, CNP
• James Peele Carey IV, M.D.
• Penny Suzanne Cesco
• Kenneth R Chapman Jr.
• Chiro Med Holistic Health Center Inc
• Krystal Clark
• Jeannine Denise Clement, M.D.
• Deborah J Cleveland, RN
• Clinton County Surgical Associates, LLC
• Code Blue Medical Services, LLC (Rivers Bend Urgent Care)

• Psychiatric/Mental Health Nurse Practitioner in Maineville, OH
• Providers in Maineville, OH by specialty
• Psychiatric/Mental Health Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2024; 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.