Katelyn Elizabeth Johnson-Clark, D.O.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

261977 Issued in NY

Practice address

5 Park SQ
Ellicottville, NY 14731-7014

Phone

(716) 257-4397

Fax

(681) 230-8216

NPI assigned

Aug 1, 2008

Last updated

Sep 3, 2025By 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

Other names 1

• Dr. Katelyn Elizabeth Clark Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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.

• Ellicottville Medical

  • Pediatrics Physician
  • Ellicottville, NY
  • NPI 1902566748
  NPD Authorized official
• Pediatric and Adolescent Urgent Care of Western New York

  dba Peds Urgent Care

  • Urgent Care Clinic/Center
  • Williamsville, NY
  • NPI 1922300516
  NPD (past)

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

{
    "created_epoch": "1217548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756857600000",
    "number": "1285890939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1252",
            "city": "ELLICOTTVILLE",
            "state": "NY",
            "postal_code": "147311252",
            "telephone_number": "941-441-7804",
            "fax_number": "681-230-8216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 PARK SQ",
            "city": "ELLICOTTVILLE",
            "state": "NY",
            "postal_code": "147317014",
            "telephone_number": "716-257-4397",
            "fax_number": "681-230-8216"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5 Park Sq",
            "address_purpose": "LOCATION",
            "city": "Ellicottville",
            "state": "NY",
            "postal_code": "147317014",
            "country_code": "US",
            "telephone_number": "716-257-4397",
            "fax_number": "681-230-8216",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON-CLARK",
        "first_name": "KATELYN",
        "middle_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-08-01",
        "last_updated": "2025-09-03",
        "certification_date": "2025-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "261977",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATELYN",
            "last_name": "CLARK",
            "middle_name": "ELIZABETH",
            "prefix": "DR.",
            "credential": "D.O.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Ellicottville Pharmacy Inc
• Ellicottville Pharmacy Inc
• General Physician, PC (Olean Medical Group)
• Diana Marie Golley, RN
• Leaudra Hackett
• Darla Jean Kent, OTD, MS, OTR/L
• Margaret Helen Kent, NP
• Sherwood Klein Jr., RPH
• Daniel Frederick Lee, LMT
• Pamela McGarry, LMHC

• Pediatrics Physician in Ellicottville, NY
• Providers in Ellicottville, NY by specialty
• Pediatrics Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2025; 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.