Kelli Clebert Corkern, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP06551 Issued in LA

Practice address

1023 W Highway 30
Gonzales, LA 70737-5002

Phone

(225) 765-5500

Fax

(225) 647-5342

NPI assigned

Oct 18, 2011

Last updated

Aug 24, 2021By 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 1

Addresses

Other identifiers 2

Other names 1

• Kelli Bridgette Clebert Former name

Electronic endpoints 2

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, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Our Lady of the Lake Physician Group LLCGroup PAC ID 4587849781, 637 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Amedisys Home Health Home health agency, Baton Rouge, LA, CCN 197437
• Our Lady of the Lake Regional Medical Center Hospital, Baton Rouge, LA, CCN 190064
• Ochsner Medical Center - Baton Rouge Hospital, Baton Rouge, LA, CCN 190202

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Our Lady of the Lake Physician Group LLC

  • Internal Medicine Physician
  • Baton Rouge, LA
  • NPI 1033494943

  Nurse Practitioner

  Medicare reassignment Care Compare group NPD
• Convenient Care LLC

  dba Lake After Hours Perkins

  • Urgent Care Clinic/Center
  • Baton Rouge, LA
  • NPI 1164422630
  Medicare reassignment NPD
• Convenient Care LLC

  dba Lake After Hours Hammond

  • Urgent Care Clinic/Center
  • Hammond, LA
  • NPI 1225119225
  NPD
• Convenient Care LLC

  dba Lake After Hours O'neal

  • Urgent Care Clinic/Center
  • Baton Rouge, LA
  • NPI 1821181801
  NPD
• Our Lady of the Lake Physician Group LLC

  dba OLOL Physician Surgical Specialty

  • Hematology & Oncology Physician
  • Baton Rouge, LA
  • NPI 1184671455

  Nurse Practitioner

  NPD (past)
• Radiology Associates LLC

  • Diagnostic Radiology Physician
  • Baton Rouge, LA
  • NPI 1659347771
  NPD (past)

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

• Amedisys Louisiana, LLC

  dba Amedisys Home Health

  • Home Health Agency
  • Baton Rouge, LA
  • NPI 1588612360
  Care Compare affiliation
• East Baton Rouge Medical Center LLC

  dba Ochsner Medical Center Baton Rouge

  • General Acute Care Hospital
  • Baton Rouge, LA
  • NPI 1053360651
  Care Compare affiliation
• Our Lady of the Lake Hospital Inc.

  dba Our Lady of the Lake Regional Medical Center

  • General Acute Care Hospital
  • Baton Rouge, LA
  • NPI 1366436123
  Care Compare affiliation

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

{
    "created_epoch": "1318896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629763200000",
    "number": "1629353990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5959 S SHERWOOD FOREST BLVD",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708166038",
            "telephone_number": "225-526-0001",
            "fax_number": "225-765-9196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1023 W HIGHWAY 30",
            "city": "GONZALES",
            "state": "LA",
            "postal_code": "707375002",
            "telephone_number": "225-765-5500",
            "fax_number": "225-647-5342"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17609 Old Jefferson Hwy Ste A",
            "address_purpose": "LOCATION",
            "city": "Prairieville",
            "state": "LA",
            "postal_code": "707693980",
            "country_code": "US",
            "telephone_number": "225-765-5500",
            "fax_number": "225-743-2888",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CORKERN",
        "first_name": "KELLI",
        "middle_name": "CLEBERT",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-10-18",
        "last_updated": "2021-08-24",
        "certification_date": "2021-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "LA",
            "license": "AP06551",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2169149",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07508799",
            "state": "MS"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0830.epihosted.com/FHIRPoxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "FMOLHS FHIR URL",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "1023 W Highway 30",
            "city": "Gonzales",
            "state": "LA",
            "country_code": "US",
            "postal_code": "707375002",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kcorkern23626@direct.casso.us.com",
            "affiliation": "N",
            "endpointDescription": "FMOLHS-Epic",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "kcorkern23626@direct.casso.us.com",
            "address_1": "1023 W Highway 30",
            "city": "Gonzales",
            "state": "LA",
            "country_code": "US",
            "postal_code": "707375002",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KELLI",
            "last_name": "CLEBERT",
            "middle_name": "BRIDGETTE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Family Nurse Practitioner in Gonzales, LA
• Providers in Gonzales, LA by specialty
• Family Nurse Practitioner in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2021; 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.