Kelly Ann Clark

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

2020000768 Issued in MO

Practice address

3202 Miller St
Bethany, MO 64424-2713

Phone

(660) 425-3154

Fax

(660) 425-6663

NPI assigned

Jan 9, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

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 1

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Harrison County Community Hospital DistrictGroup PAC ID 4587630926, 21 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Harrison County Community Hospital Hospital, Bethany, MO, CCN 261312

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.

• Harrison County Community Hospital District

  • Rural Health Clinic/Center
  • Bethany, MO
  • NPI 1154645745

  Family Medicine, MO

  Medicare reassignment Care Compare group NPD
• Harrison County Community Hospital District

  • Critical Access Hospital
  • Bethany, MO
  • NPI 1528062569
  Care Compare group NPD (past)
• Harrison County Community Hospital District

  • Rural Health Clinic/Center
  • Eagleville, MO
  • NPI 1114348083
  Care Compare group
• Harrison County Community Hospital District

  • Rural Health Clinic/Center
  • Pattonsburg, MO
  • NPI 1184423329
  Care Compare group
• Harrison County Community Hospital District

  • Medicare Defined Swing Bed Hospital Unit
  • Bethany, MO
  • NPI 1265512917
  Care Compare group
• Harrison County Community Hospital District

  • Family Medicine Physician
  • Pattonsburg, MO
  • NPI 1285427104

  Family Medicine

  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Harrison County Community Hospital District

  • Critical Access Hospital
  • Bethany, MO
  • NPI 1528062569

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1578528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616025600000",
    "number": "1164062972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3202 MILLER ST",
            "city": "BETHANY",
            "state": "MO",
            "postal_code": "644242713",
            "telephone_number": "660-425-3154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3202 MILLER ST",
            "city": "BETHANY",
            "state": "MO",
            "postal_code": "644242713",
            "telephone_number": "660-425-3154",
            "fax_number": "660-425-6663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KELLY",
        "middle_name": "ANN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-09",
        "last_updated": "2021-03-18",
        "certification_date": "2021-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2020000768",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2020000768",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephen Kyle Butts
• Cameron Regional Medical Center Inc
• Cameron Regional Medical Center, Inc
• Shanna Marie Campbell, MS CCC-SLP
• Karin Cha, DO
• George Matthew Craig
• Gregory A Dean, M.D.
• Deanna Rae Dinwiddie, LMSW
• Douglas Faulkner, RPH
• Gentry County Association for Retarded Citizens, Inc.

• All providers in Bethany, MO
• Family Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2021; 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.

Verify at the official NPI Registry.