Kendall Leigh Clark, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-12569 Issued in NC

Practice address

11200 Governor Manly Way Ste 205
Raleigh, NC 27614-7367

Phone

(919) 570-7700

Fax

(919) 570-7701

NPI assigned

Sep 19, 2022

Last updated

Nov 7, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NC

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

Physician Assistant

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Unc Physicians Network LLCGroup PAC ID 5496940546, 985 clinicians

Carolina Physical Therapy Associates LLCGroup PAC ID 7012989684, shared by 7 NPIs, 496 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Rex Hospital Hospital, Raleigh, NC, CCN 340114

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kclark1114576@direct.unc.nchie.net

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.

• Unc Physicians Network LLC

  dba UNC Family Medicine at Pittsboro

  • Family Medicine Physician
  • Pittsboro, NC
  • NPI 1750704367
  Medicare reassignment Care Compare group
• Cornerstone Family Practice & Urgent Care, PLLC

  • Primary Care Clinic/Center
  • Fayetteville, NC
  • NPI 1083087837
  Medicare reassignment
• Unc Physicians Network LLC

  • General Practice Physician
  • Morrisville, NC
  • NPI 1558786830
  NPD
• Unc Physicians Network LLC

  dba UNC Family Medicine at Hillsborough

  • Family Medicine Physician
  • Hillsborough, NC
  • NPI 1922422294
  NPD
• Womens Health Haven Obstetrics and Gynecology

  • Obstetrics & Gynecology Physician
  • Fayetteville, NC
  • NPI 1477784080
  NPD
• FHPG, LLC

  • Family Medicine Physician
  • Fayetteville, NC
  • NPI 1396676284
  NPD (past)

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

• Rex Hospital Inc.

  dba Rex Hospital

  • General Acute Care Hospital
  • Raleigh, NC
  • NPI 1497797088
  Care Compare affiliation

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

{
    "created_epoch": "1663545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730937600000",
    "number": "1225750995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5221 PARAMOUNT PKWY STE 220",
            "city": "MORRISVILLE",
            "state": "NC",
            "postal_code": "275605490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11200 GOVERNOR MANLY WAY STE 205",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276147367",
            "telephone_number": "919-570-7700",
            "fax_number": "919-570-7701"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1536 Owen Park Ln",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "NC",
            "postal_code": "283043454",
            "country_code": "US",
            "telephone_number": "910-307-1576",
            "fax_number": "910-500-3117",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KENDALL",
        "middle_name": "LEIGH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-19",
        "last_updated": "2024-11-07",
        "certification_date": "2024-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-12569",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kclark1114576@direct.UNC.nchie.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "11200 Governor Manly Way Ste 205",
            "city": "Raleigh",
            "state": "NC",
            "country_code": "US",
            "postal_code": "276147367",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• George Thomas Clark III, MD
• Jill Page Clark, COTA/L
• Jon Clark
• Juliana Jackson Clark, M.D.
• Karolina Ostapkiewicz Clark, C.P.O.
• Ladonna M Clark, MA, LCAS
• Lauren Clark, OTR/L
• Martin Vincent Clark Jr., DDS
• Mary Clark, DACM
• Nakima Kinte Clark

• Physician Assistant in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2024; 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.