Kendall Clark, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

APRN-FNP209683 Issued in GA

Practice address

715 W Ogeechee St
Sylvania, GA 30467-8693

Phone

(912) 451-4100

Fax

(912) 451-4105

NPI assigned

Feb 5, 2015

Last updated

Oct 20, 2026By 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

Medicare fee-for-service enrollment

Enrolled in GA

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, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Optim Medical Center - Screven Hospital, Sylvania, GA, CCN 111312
• East Georgia Regional Medical Center Hospital, Statesboro, GA, CCN 110075

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kendall.clark.1@31306.direct.athenahealth.com

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.

• Clark Family Care LLC

  dba Clark Family Care

  • Primary Care Clinic/Center
  • Sylvania, GA
  • NPI 1114594389
  Medicare reassignment NPD Authorized official
• Screven County Family Health Center, LLC

  dba Optim Primary Care - Sylvania

  • Rural Health Clinic/Center
  • Sylvania, GA
  • NPI 1841432044

  Family Medicine

  NPD (past)

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

• East Georgia Regional Medical Center, LLC

  • General Acute Care Hospital
  • Statesboro, GA
  • NPI 1265486278
  Care Compare affiliation
• Screven County Hospital, LLC

  dba Optim Medical Center - Screven

  • Critical Access Hospital
  • Sylvania, GA
  • NPI 1225339898
  Care Compare affiliation

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

{
    "created_epoch": "1423094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1792454400000",
    "number": "1821489337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "715 W OGEECHEE ST",
            "city": "SYLVANIA",
            "state": "GA",
            "postal_code": "304678693",
            "telephone_number": "912-451-4100",
            "fax_number": "912-531-7465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 W OGEECHEE ST",
            "city": "SYLVANIA",
            "state": "GA",
            "postal_code": "304678693",
            "telephone_number": "912-451-4100",
            "fax_number": "912-451-4105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KENDALL",
        "name_prefix": "Mrs.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-02-05",
        "last_updated": "2026-10-20",
        "certification_date": "2026-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "GA",
            "license": "APRN-FNP209683",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "APRN-FNP209683",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "APRN-FNP209683",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashlyn Nicole Bazemore, LPN
• Dawn Bello, PHD, DSM, CHHP, CHWC
• Hattie Hodges Brannen, FNP-C
• Lori W Burns, LPC
• Clark Family Care LLC (Clark Family Care)
• Brielle Nicole Clarkson, LPC
• Clifford Avenue Dental LLC (Screven Dental)
• Community Service Board of Middle Georgia
• Community Service Board of Middle Georgia
• Community Service Board of Middle Georgia

• Family Nurse Practitioner in Sylvania, GA
• Providers in Sylvania, GA by specialty
• Family Nurse Practitioner in Georgia

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