Keely Clark-Mills, RN

Primary specialty

Case Management Registered NurseTaxonomy code 163WC0400X

License

2258668 Issued in MA

Practice address

335 Hillberg Ave
Brockton, MA 02301-6364

Phone

(617) 820-6848

NPI assigned

Sep 4, 2020

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

Interoperability endpoints

• Direct secure messaging: keely.clarkmills@ccalliance.eclinicaldirectplus.com

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

{
    "created_epoch": "1599177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599177600000",
    "number": "1497369698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "335 HILLBERG AVE",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023016364",
            "telephone_number": "617-820-6848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "335 HILLBERG AVE",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023016364",
            "telephone_number": "617-820-6848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK-MILLS",
        "first_name": "KEELY",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-09-04",
        "last_updated": "2020-09-04",
        "certification_date": "2020-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Registered Nurse, Case Management",
            "state": "MA",
            "license": "2258668",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• City of Brockton Health Department
• CK Wellness PLLC
• Patricia Ann Clabough
• Kevin C. Clancy, PH.D.
• Nyshi Clark Ford
• Douglas James Clark, LICSW
• Gayle Ann Clark, LICSW
• Maryelizabeth Clark, BS
• Morgan Clark
• Nicole M Clark

• All providers in Brockton, MA
• Case Management Registered Nurse in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.