Katelynn Clark, DNP-FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

F07240676 Issued in NC

Practice address

114 Cabinet Shop Rd
Maxton, NC 28364-8963

Phone

(910) 785-5351

NPI assigned

Jul 12, 2024

Last updated

Jul 12, 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

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

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.

• Liberty Medical Care Services, LLC

  • Nurse Practitioner
  • Whiteville, NC
  • NPI 1174920300
  Medicare reassignment NPD

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

{
    "created_epoch": "1720742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720742400000",
    "number": "1346087764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 CABINET SHOP RD",
            "city": "MAXTON",
            "state": "NC",
            "postal_code": "283648963",
            "telephone_number": "910-785-5351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 CABINET SHOP RD",
            "city": "MAXTON",
            "state": "NC",
            "postal_code": "283648963",
            "telephone_number": "910-785-5351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KATELYNN",
        "credential": "DNP-FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-12",
        "last_updated": "2024-07-12",
        "certification_date": "2024-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "F07240676",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Janet Marie Campbell, LCSWA, LCAS-R
• Care Ride Express
• Chaparral Youth Services
• Kylene Chavis, RRT
• Choice Imaging, LLC
• John R Clay I, CERTIFIED PEDORTHIST
• Kimberly Suzanne Collins, FNP
• Ashley Cheree Cooper
• Hannah Cummings
• Kresa Maude Cummings, PHARMD,MSW,LCSW,LCAS

• Family Nurse Practitioner in Maxton, NC
• Providers in Maxton, NC by specialty
• Family Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.