Kendall Clark, FNP-C
Individual provider Active NPI Family Nurse Practitioner · Sylvania, GA
NPI 1821489337 · NPPES record last updated Mar 1, 2023
Key facts
- NPI
- 1821489337
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- RN209683 (GA)
- Practice address
- 715 W Ogeechee St
Sylvania, GA 30467-8693 - Phone
- (912) 451-4100
- Fax
- (912) 451-4105
- NPI assigned
- Feb 5, 2015
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
715 W Ogeechee St
Sylvania, GA 30467-8693
Phone (912) 451-4100
Hospital & facility affiliations
- Optim Medical Center - Screven
- East Georgia Regional Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- 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 |
|---|---|---|---|---|
| I20151020000676 | GA | Practitioner - Nurse Practitioner | 3678882339 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN209683 | GA | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Clark Family Care LLC | Current |
Accepting new patients | |
| Screven County Family Health Center, LLC | Past | Accepting new patients |
Locations
121 N Main St
Sylvania, GA 30467
Phone (912) 531-7465
715 W Ogeechee St
Sylvania, GA 30467
Phone (912) 451-4100
Interoperability endpoints
- kendall.clark.1@31306.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | RN209683 | GA | Yes |
Addresses
Primary practice location
715 W Ogeechee St
Sylvania, GA 30467-8693
Mailing address
PO Box 194
Sylvania, GA 30467-0194
Phone (912) 451-4100
Other providers in Sylvania, GA
- Ashlyn Nicole Bazemore
- Dawn Bello
- Hattie Hodges Brannen
- Lori W Burns
- Clark Family Care LLC
- Brielle Nicole Clarkson
- Clifford Avenue Dental LLC
- Community Service Board of Middle Georgia
- Community Service Board of Middle Georgia
- Community Service Board of Middle Georgia
All providers in Sylvania, GA · Family Nurse Practitioner in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 1, 2023. 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.