Kelly O'Brian Clark, R.N., M.S.N., F.N.P.

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

71000435A Issued in IN

Practice address

1002 S Edgewood Dr
Knox, IN 46534-8226

Phone

(574) 772-6030

Fax

(574) 772-7494

NPI assigned

Oct 12, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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 IN

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, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Laporte County Comprehensive Mental Health CouncilGroup PAC ID 3274703046, 20 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner, Registered Nurse

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Laporte County Comprehensive Mental Health Council

  dba Swanson Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Michigan City, IN
  • NPI 1295746816
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1811086903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1002 S EDGEWOOD DR",
            "city": "KNOX",
            "state": "IN",
            "postal_code": "465348226",
            "telephone_number": "574-772-6030",
            "fax_number": "574-772-7494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1002 S EDGEWOOD DR",
            "city": "KNOX",
            "state": "IN",
            "postal_code": "465348226",
            "telephone_number": "574-772-6030",
            "fax_number": "574-772-7494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KELLY",
        "middle_name": "O'BRIAN",
        "name_prefix": "Mr.",
        "credential": "R.N., M.S.N., F.N.P.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "IN",
            "license": "71000435A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Emily Chatham, MOT, OTR/L
• Cni Starke LLC (Starke Memorial Hospital)
• Cni Starke, LLC (Charles Stone Surgical)
• Daniel Cole, FNP-C
• Crystal Combs, CNA
• Community Home Care Services Inc

• Adult Health Nurse Practitioner in Knox, IN
• Providers in Knox, IN by specialty
• Adult Health Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.