Kenyatta Clark

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Practice address

4502 Fair Ave
Saint Louis, MO 63115-3053

Phone

(314) 793-0251

NPI assigned

Jan 16, 2024

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• A Place to Mend Residential & Home Healthcare LLC

  • Home Health Agency
  • Saint Louis, MO
  • NPI 1609615400
  NPD Authorized official

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

{
    "created_epoch": "1705363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705363200000",
    "number": "1922879121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4502 FAIR AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631153053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4502 FAIR AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631153053",
            "telephone_number": "314-793-0251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KENYATTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-01-16",
        "last_updated": "2024-01-16",
        "certification_date": "2024-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joan Marie Clark, ANP
• Joseph B Clark
• Kailen Matthew Clark
• Kathryn Clark, PA-C
• Kelly Ann Clark, FNP
• Kristen Marie Clark, NNP-BC
• Lanyn Clark
• Laylah Clark
• Martha Elizabeth Clark, MSW, LCSW
• Megan Clark

• Home Health Agency in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Home Health Agency in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.