Kimberly Ann Clark, RN MSN FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

1014028 Issued in TX

Practice address

307 East 9TH Street
Wheeler, TX 79096-1030

Phone

(580) 558-8543

Fax

(630) 570-6352

NPI assigned

Dec 31, 2019

Last updated

Oct 20, 2020By 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 3

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TX, OK2 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, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Williams Medical Group Practice, LLCGroup PAC ID 3375832157, 212 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner, Registered Nurse

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kimberly.a.clark121.civ@mail.mil

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.

• Williams Medical Group Practice, LLC

  dba Integrity Urgent Care

  • Family Medicine Physician
  • Lawton, OK
  • NPI 1346608809
  Medicare reassignment Care Compare group NPD
• North Wheeler County Hospital District

  dba Parkview Rural Health Clinic

  • Rural Health Clinic/Center
  • Wheeler, TX
  • NPI 1326445693
  Medicare reassignment NPD
• North Wheeler County Hospital District

  dba Parkview Hospital

  • Critical Access Hospital
  • Wheeler, TX
  • NPI 1396748471
  Medicare reassignment NPD
• Williams Medical Group Practice, LLC

  dba Integrity Urgent Care

  • Rural Health Clinic/Center
  • Collinsville, OK
  • NPI 1215751508
  NPD
• North Wheeler County Hospital District

  dba Parkview Hospital Home Health Agency

  • Home Health Agency
  • Wheeler, TX
  • NPI 1649280876
  NPD (past)

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

{
    "created_epoch": "1577750400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603152000000",
    "number": "1508405028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2401 NW 13TH ST",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735072608",
            "telephone_number": "580-678-8081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 EAST 9TH STREET",
            "city": "WHEELER",
            "state": "TX",
            "postal_code": "790961030",
            "telephone_number": "580-558-8543",
            "fax_number": "630-570-6352"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "901 South Sweetwater Street",
            "address_purpose": "LOCATION",
            "city": "Wheeler",
            "state": "TX",
            "postal_code": "790961030",
            "country_code": "US",
            "telephone_number": "806-826-5581",
            "fax_number": "806-826-3201",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KIMBERLY",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "RN MSN FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-31",
        "last_updated": "2020-10-20",
        "certification_date": "2020-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Case Management",
            "state": "OK",
            "license": "95760",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OK",
            "license": "F05200738",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1014028",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Kimberly.a.clark121.civ@mail.mil",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "4301 Wilson St",
            "city": "Fort Sill",
            "state": "OK",
            "country_code": "US",
            "postal_code": "735034472",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kinley Lindell Aikin-Fisk, PTA
• Autumn Bridges, PT
• Connaught Medical Practice PLLC
• Callie A Crouch, NP-C
• Afshin Edrissi, DO
• Baiely Flynn, DPT
• Robert C Galutia, MD

• Family Nurse Practitioner in Wheeler, TX
• Providers in Wheeler, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2020; 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.