Keressa L. Clark, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

21571 Issued in TN

Practice address

111 W Stone Dr
Suite 110
Kingsport, TN 37660-6027

Phone

(423) 224-3701

Fax

(423) 224-3709

NPI assigned

Jul 20, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TN, NC2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Appalachian Regional Medical Associates IncGroup PAC ID 5799877817, 147 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Charles a Cannon Jr Memorial Hospital Hospital, Linville, NC, CCN 341323

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kclark1013751@direct.unc.nchie.net
• Direct secure messaging: keressaclark@arhs.allscriptsdirect.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Appalachian Regional Medical Associates, Inc.

  • Family Medicine Physician
  • Boone, NC
  • NPI 1669533923
  Medicare reassignment Care Compare group NPD
• Wellmont Medical Associates Inc

  • Pulmonary Disease Physician
  • Kingsport, TN
  • NPI 1780986257
  Medicare reassignment NPD
• Wellmont Medical Associates, Inc.

  • Internal Medicine Physician
  • Kingsport, TN
  • NPI 1598124398
  NPD

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

• Charles a Cannon Jr Memorial Hospital Inc

  • Psychiatric Hospital Unit
  • Linville, NC
  • NPI 1407006968
  Care Compare affiliation
• Charles a Cannon Jr Memorial Hospital Inc.

  • Critical Access Hospital
  • Linville, NC
  • NPI 1225088255
  Care Compare affiliation

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

{
    "created_epoch": "1468972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473811200000",
    "number": "1346693868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 W STONE DR",
            "address_2": "SUITE 6A",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376603365",
            "telephone_number": "423-408-7220",
            "fax_number": "423-408-7405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 W STONE DR",
            "address_2": "SUITE 110",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376606027",
            "telephone_number": "423-224-3701",
            "fax_number": "423-224-3709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KERESSA",
        "middle_name": "L.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-20",
        "last_updated": "2016-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024173732",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "21571",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gloria Michelle Christy, BS
• Clayton Tomas Chroust, AGACNP, DNP
• Kelly Dwayne Chumbley, DO
• City Drug L.L.C
• Graycen Clark, MSN, APRN, FNP-BC
• Rita Joan Clatworthy, NP
• Clearsight Vision Center, LLC
• Clemson Enterprise PLLC
• Rebecca Daye Click, M.S., CCC-SLP
• Thomas Click

• Family Nurse Practitioner in Kingsport, TN
• Providers in Kingsport, TN by specialty
• Family Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2016; 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.