Active NPI
Kristen Clark
- Family Nurse Practitioner
- Okatie, SC
National Provider Identifier
1124902309
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 30794
- Practice address
- 122 Okatie Center Blvd N Ste 240
Okatie, SC 29909-3782 - Phone
- (843) 832-7925
- NPI assigned
- Aug 1, 2025
- Last updated
- Aug 1, 2025
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 30794 | SC | Primary |
Addresses
Primary practice location
122 Okatie Center Blvd N Ste 240
Okatie, SC 29909-3782
Mailing address
9 Chestnut St
Beaufort, SC 29906-2414
Phone (803) 508-3043
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2025
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
9 Chestnut St
Beaufort, SC 29906-2414
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Coastal Neurology, P.a. | Current | Accepting new patients |
Locations
122 Okatie Center Blvd N
Ste 240
Okatie, SC 29909
Phone (843) 522-1420
1833 N Paris Ave
Port Royal, SC 29935
Phone (843) 522-1420
Organizations & group practices 1
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.
-
- Neurology Physician
- Port Royal, SC
- NPI 1750346789
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1754006400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1754006400000",
"number": "1124902309",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9 CHESTNUT ST",
"city": "BEAUFORT",
"state": "SC",
"postal_code": "299062414",
"telephone_number": "803-508-3043"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "122 OKATIE CENTER BLVD N STE 240",
"city": "OKATIE",
"state": "SC",
"postal_code": "299093782",
"telephone_number": "843-832-7925"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "KRISTEN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-08-01",
"last_updated": "2025-08-01",
"certification_date": "2025-08-01",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "SC",
"license": "30794",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Okatie, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2025; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.