Kathleen A Clark, FNP
Individual provider Active NPI Family Nurse Practitioner · Bluffton, IN
NPI 1245259167 · NPPES record last updated Nov 4, 2015
Key facts
- NPI
- 1245259167
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 74001171A (IN)
- Practice address
- 1100 S Main St
Bluffton, IN 46714-3615 - Phone
- (260) 919-3900
- Fax
- (260) 919-3913
- NPI assigned
- Jul 19, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 74001171A | IN | MD | Family Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 74001171A | IN | Yes |
Addresses
Primary practice location
1100 S Main St
Bluffton, IN 46714-3615
Mailing address
1100 S Main St
Bluffton, IN 46714-3615
Phone (260) 919-3900
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200334940 | Medicaid | IN |
Other providers in Bluffton, IN
- Juanita E Bryan
- Carol J Butler
- Adam Carroll
- Caylor Nickel Clinic, PC
- Grace Elaine Cebalt
- Clear Chiropractic Granger, LLC
- Complete Smiles, Inc.
- Jennifer Cook
- Timothy Michael Cooley
- Darryl L Coty
All providers in Bluffton, IN · Family Nurse Practitioner in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 4, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.