Kimberly Ann Clark, RN MSN FNP-C
Individual provider Active NPI Family Nurse Practitioner · Wheeler, TX
NPI 1508405028 · NPPES record last updated Oct 20, 2020
Key facts
- NPI
- 1508405028
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 1014028 (TX)
- Practice address
- 307 East 9TH Street
Wheeler, TX 79096-1030 - Phone
- (580) 558-8543
- Fax
- (630) 570-6352
- NPI assigned
- Dec 31, 2019
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Williams Medical Group Practice, LLC
Practice addresses (Care Compare)
2088 N Hwy 81
Duncan, OK 73533-1416
Phone (580) 606-6201
220 S Van Buren St
Xpress Wellness Urgent Care
Enid, OK 73703-5812
Phone (580) 234-9355
411 W Grand Ave
Xpress Wellness Urgent Care
Chickasha, OK 73018-5862
Phone (405) 224-0053
6744 NW Cache Rd
Xpress Wellness Urgent Care
Lawton, OK 73505-2702
Phone (580) 536-9355
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TX, OK
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20201109000441 | TX | Practitioner - Nurse Practitioner | 1759791403 | Reassigns benefits to 2 organizations |
| I20250109000879 | OK | Practitioner - Nurse Practitioner | 1759791403 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Science - Nursing, Nurse Practitioner, Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 95760 | OK | MD | Case Management Registered Nurse |
| F05200738 | OK | MD | Family Nurse Practitioner |
| 1014028 | TX | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| North Wheeler County Hospital District | Current |
Accepting new patients | |
| Williams Medical Group Practice, LLC | Current |
Accepting new patients | |
| Williams Medical Group Practice, LLC | Current |
Accepting new patients | |
| North Wheeler County Hospital District | Current |
Accepting new patients | |
| North Wheeler County Hospital District | Past | Accepting new patients |
Locations
1120 N Highway 81
Duncan, OK 73533
Phone (580) 536-9355
220 S Van Buren St
Enid, OK 73703
Phone (580) 234-9355
777 NW 63rd St
Fl 2
Oklahoma City, OK 73116
Interoperability endpoints
- kimberly.a.clark121.civ@mail.mil
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Management Registered Nurse | 163WC0400X | 95760 | OK | |
| Family Nurse Practitioner | 363LF0000X | F05200738 | OK | |
| Family Nurse Practitioner | 363LF0000X | 1014028 | TX | Yes |
Addresses
Primary practice location
307 East 9TH Street
Wheeler, TX 79096-1030
Mailing address
2401 NW 13TH St
Lawton, OK 73507-2608
Phone (580) 678-8081
Other practice location 1
901 South Sweetwater Street
Wheeler, TX 79096-1030
Phone (806) 826-5581
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | Kimberly.a.clark121.civ@mail.mil | Direct |
Other providers in Wheeler, TX
- Kinley Lindell Aikin-Fisk
- Autumn Bridges
- Connaught Medical Practice PLLC
- Callie A Crouch
- Afshin Edrissi
- Baiely Flynn
- Robert C Galutia
All providers in Wheeler, TX · Family Nurse Practitioner in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 20, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.