Kimberlee Ann Clark-Raby, A.G.N.P.-BC

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

21308 Issued in CA

Practice address

1161 Cirby Way
Roseville, CA 95661-4421

Phone

(916) 782-1238

NPI assigned

Feb 5, 2009

Last updated

Nov 20, 2014By 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 2

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

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

Specialty

Nurse Practitioner

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

St Tammany Parish Hospital Service District No 1Group PAC ID 0749273761, shared by 6 NPIs, 162 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Tammany Parish Hospital Hospital, Covington, LA, CCN 190045

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/19797/brand/1/csg/1/fhir/r4

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.

• St Tammany Parish Hospital Service District No 1

  dba St Tammany Physicians Network

  • Internal Medicine Physician
  • Covington, LA
  • NPI 1083793582
  Medicare reassignment NPD
• St. Tammany Parish Hospital Service District No 1

  dba St. Tammany Parish Hospital

  • General Acute Care Hospital
  • Covington, LA
  • NPI 1598798597
  Medicare reassignment NPD
• Capital Medical Extended Care

  • Skilled Nursing Facility
  • Sacramento, CA
  • NPI 1295131092
  NPD (past)

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

• St Tammany Parish Hospital Service District No 1

  dba St Tammany Physicians Network

  • Internal Medicine Physician
  • Covington, LA
  • NPI 1083793582

  Hospital

  Care Compare affiliation
• St Tammany Parish Hospital Service District No 1

  dba Northlake Pulmonary Associates at St Tammany Parish Hospital

  • Pulmonary Disease Physician
  • Covington, LA
  • NPI 1285285874

  Hospital

  Care Compare affiliation
• St. Tammany Parish Hospital Service District No 1

  dba St. Tammany Parish Hospital

  • General Acute Care Hospital
  • Covington, LA
  • NPI 1598798597
  Care Compare affiliation

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

{
    "created_epoch": "1233792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1416441600000",
    "number": "1356580906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3001 DOUGLAS BLVD",
            "address_2": "#150",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956613851",
            "telephone_number": "916-241-9844",
            "fax_number": "916-241-9845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1161 CIRBY WAY",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956614421",
            "telephone_number": "916-782-1238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK-RABY",
        "first_name": "KIMBERLEE",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "A.G.N.P.-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-02-05",
        "last_updated": "2014-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "CA",
            "license": "21308",
            "primary": true
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "CA",
            "license": "21308",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Danika Cisneros
• City of Roseville (City of Roseville Fire Deparment)
• Paris Clack, PT
• Marc William Clanton
• Fariba Clapper, PHARMD
• Apryl Marie Clark
• Felice Clark, MS SLP
• Ikea Zorie Alexandra Clark, DPT, PT
• Jefferson Clark, DDS
• Jordan Michael Clark, DO

• Adult Health Nurse Practitioner in Roseville, CA
• Providers in Roseville, CA by specialty
• Adult Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2014; 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.