Kenneth Bryan Clark, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

103056 Issued in NC

Practice address

810 Mitchell Ave
Salisbury, NC 28144-6253

Phone

(704) 603-1403

Fax

(704) 603-1517

NPI assigned

May 25, 2006

Last updated

Sep 11, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

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

Specialty

Physician Assistant

Education

Other, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Novant Health Medical Group, LLCGroup PAC ID 1153234893, 2,413 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Novant Health Rowan Medical Center Hospital, Salisbury, NC, CCN 340015
• Novant Health Thomasville Medical Center Hospital, Thomasville, NC, CCN 340085

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Novant Health Medical Group, LLC

  dba Novant Health Pediatric Neurology & Sleep

  • Neurology with Special Qualifications in Child Neurology Physician
  • Charlotte, NC
  • NPI 1366409492
  Medicare reassignment Care Compare group
• Novant Health Medical Group, LLC

  dba Novant Health Elizabeth OB/GYN

  • Obstetrics & Gynecology Physician
  • Matthews, NC
  • NPI 1386506137
  NPD
• Novant Health Medical Group, LLC

  dba Novant Health Orthopedics & Sports Medicine

  • Orthopaedic Surgery Physician
  • Charlotte, NC
  • NPI 1972737195
  NPD
• Novant Health Medical Group, LLC

  dba Novant Health Northlake Dermatology

  • Dermatopathology Physician
  • Huntersville, NC
  • NPI 1396751640
  NPD (past)

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

• Novant Health Rowan Medical Center LLC

  dba Novant Health Rowan Medical Center

  • General Acute Care Hospital
  • Salisbury, NC
  • NPI 1508843566
  Care Compare affiliation
• Novant Health Thomasville Medical Center, LLC

  dba Novant Health Thomasville Medical Center

  • General Acute Care Hospital
  • Thomasville, NC
  • NPI 1801848767
  Care Compare affiliation

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

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694390400000",
    "number": "1417903287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 602362",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282602362",
            "telephone_number": "704-216-5633",
            "fax_number": "704-639-0785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 MITCHELL AVE",
            "city": "SALISBURY",
            "state": "NC",
            "postal_code": "281446253",
            "telephone_number": "704-603-1403",
            "fax_number": "704-603-1517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KENNETH",
        "middle_name": "BRYAN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-25",
        "last_updated": "2023-09-11",
        "certification_date": "2023-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "103056",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "KCLARK35002@DIRECT.NOVANTHEALTH.ORG",
            "affiliation": "N",
            "address_1": "810 Mitchell Ave",
            "city": "Salisbury",
            "state": "NC",
            "country_code": "US",
            "postal_code": "281446253",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Karla Christy, DC
• Gavin Christopher Cianci, PA-C
• Latonia Clark-Chalmers
• Donna Marie Clark-Riddle, CRNA
• Erica Michele Clark, LCSW
• Robert Andrew Clarke, CADC
• William Deavor Clarke, PHYSICAL THERAPIST
• Pamela Lynn Clay, FNP
• Ashleigh Lynn Cline, OTA/L
• Wayne Allen Cline Jr., MD

• Physician Assistant in Salisbury, NC
• Providers in Salisbury, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2023; 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.