Kymberli A. Mumford-Clarke, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN0015848 Issued in FL

Practice address

2804 Saint Johns Bluff Rd S Ste 200
Jacksonville, FL 32246-3778

Phone

(904) 493-1005

Fax

(904) 345-2961

NPI assigned

Jul 17, 2006

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 identifiers 1

Other names 1

• Kymberli A. Mumford Former name

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• North Florida Rural Health Corp

  • Multi-Specialty Clinic/Center
  • Chattahoochee, FL
  • NPI 1912641341
  Medicare reassignment NPD
• Kayc Group PA

  dba A Better Smile Denture Center

  • General Practice Dentistry
  • Jacksonville, FL
  • NPI 1538592993
  NPD Authorized official
• North Florida Rural Health Corp

  • Community/Retail Pharmacy
  • Chattahoochee, FL
  • NPI 1720849540
  NPD

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745366400000",
    "number": "1316965742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2804 SAINT JOHNS BLUFF RD S STE 200",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322463778",
            "telephone_number": "904-493-1005",
            "fax_number": "904-345-2961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2804 SAINT JOHNS BLUFF RD S STE 200",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322463778",
            "telephone_number": "904-493-1005",
            "fax_number": "904-345-2961"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "680 Maple St",
            "address_purpose": "LOCATION",
            "city": "Chattahoochee",
            "state": "FL",
            "postal_code": "323241826",
            "country_code": "US",
            "telephone_number": "850-759-9223",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MUMFORD-CLARKE",
        "first_name": "KYMBERLI",
        "middle_name": "A.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-17",
        "last_updated": "2025-04-23",
        "certification_date": "2025-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN0015848",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "075583400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KYMBERLI",
            "last_name": "MUMFORD",
            "middle_name": "A.",
            "credential": "DDS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Multipayl, Inc.
• Sean Mulvaney
• Andrew King Mulville, PA-C
• Sara Marie Mulville, PA-C
• Mumda
• Kaylee Munch, MOT, OTR/L
• Bridget Rose Courtney Muncy, RBT
• Arlee Ann Mundy, CRNA
• Helen Breene Mundy
• John D Mundy, CRNA

• General Practice Dentistry in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.