Bethany Kristin Clark, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95026372 Issued in CA

Practice address

101 Laguna Rd Ste 200
Fullerton, CA 92835-3601

Phone

(714) 992-5350

Fax

(714) 446-5539

NPI assigned

Aug 22, 2023

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

Enrolled in CA

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, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Providence Medical FoundationGroup PAC ID 8921993205, shared by 2 NPIs, 1,461 clinicians

OB-GYN Place a Medical CorporationGroup PAC ID 9739185703, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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 and National Provider Directory roles.

• OB-GYN Place a Medical Corporation

  • Obstetrics & Gynecology Physician
  • Arcadia, CA
  • NPI 1699786293
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1692662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781654400000",
    "number": "1639953433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "706 PARK SHADOW CT",
            "city": "BALDWIN PARK",
            "state": "CA",
            "postal_code": "917063266",
            "telephone_number": "626-589-0481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 LAGUNA RD STE 200",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928353601",
            "telephone_number": "714-992-5350",
            "fax_number": "714-446-5539"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "706 Park Shadow Ct",
            "address_purpose": "LOCATION",
            "city": "Baldwin Park",
            "state": "CA",
            "postal_code": "917063266",
            "country_code": "US",
            "telephone_number": "626-589-0481",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "BETHANY",
        "middle_name": "KRISTIN",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-08-22",
        "last_updated": "2026-06-17",
        "certification_date": "2026-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95026372",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marlo Yvonne Cisneros
• Viridiana Cisneros
• City of Fullerton
• Clarity Pharmacy Consulting Inc.
• Aubrey Rose Clark
• Carrie-Anne Clark, PA-C
• Madison Mimi Clark
• Olivia Clark
• Tracey Clark, M.A., LMFT
• Clarke Lew Medical Corp

• Family Nurse Practitioner in Fullerton, CA
• Providers in Fullerton, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2026; 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.