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KELLY STARK
NPI 1114343985
Social Worker in Ammon, ID

Active since March 17, 2014PECOS Enrolled
2705 E 17TH ST, AMMON, ID 83406(208) 346-7500(208) 346-7501 Get Directions Write a Review

NPPES record last updated: November 25, 2025. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Kelly Stark NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KELLY STARK (NPI 1114343985) is an individual social worker in Ammon, Idaho, licensed in Idaho (LMSW-33495) and active in the NPI registry since March 2014. She is enrolled in Medicare PECOS and is a graduate of Other (2011).

NPPES Registry Identity

NPI1114343985
Entity TypeIndividualFemale
Primary Taxonomy104100000X
Provider Legal NameKELLY STARK
Location Address2705 E 17TH STAmmon, ID 83406-6669
Mailing Address2705 E 17th StAmmon, ID 83406-6669 · (208) 346-7500 · Fax (208) 346-7501
Phone(208) 346-7500
Fax(208) 346-7501
Sole ProprietorNo
Medical School CMSOtherGraduated 2011
Enumeration DateMarch 17, 2014
Last NPPES UpdateNovember 25, 2025
NPPES CertifiedNovember 25, 2025
✔ NPI 1114343985 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial WorkerBehavioral Health & Social Service Providers
Taxonomy Code104100000X
License✔ Licensed in ID · LMSW-33495
Definition
A social worker is a person who is qualified by a Social Work degree, and licensed, certified or registered by the state as a social worker to practice within the scope of that license. A social worker provides assistance and counseling to clients and their families who are dealing with social, emotional and environmental problems. Social work services may be rendered to individuals, families, groups, and the public.
2705 E 17TH ST, Ammon, ID 83406
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kelly Stark is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID1658889464
PECOS Enrollment IDI20250804001204
Eligible to Order & Refer– Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JAYDE BARNES PMHNP
Nurse Practitioner (Psychiatric/Mental Health)
2705 E 17TH ST
AMMON, ID 83406
Bonneville County (208) 346-7500
JODI LYNN DENNETT
Counselor (Mental Health)
2705 E 17TH ST
AMMON, ID 83406
Bonneville County (208) 346-7500
SARAH CLARK
Peer Specialist
2705 E 17TH ST
AMMON, ID 83406
Bonneville County (208) 346-7500
SIU LING CHI
Counselor (Professional)
2705 E 17TH ST
AMMON, ID 83406
Bonneville County (208) 346-7500
MRS. STEVIE N CLAXTON LMSW
Social Worker
2705 E 17TH ST
AMMON, ID 83406
Bonneville County (208) 346-7500
DANIELA UGARTE RODRIGUEZ
Counselor (Mental Health)
2705 E 17TH ST
AMMON, ID 83406
Bonneville County (208) 346-7500
COLIN WATERS
Counselor (Professional)
2705 E 17TH ST
AMMON, ID 83406
Bonneville County (208) 346-7500
CLAIRE MCISAAC LSW
Social Worker
2705 E 17TH ST
AMMON, ID 83406
Bonneville County (208) 346-7500

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kelly Stark's NPI number?

The NPI number for Kelly Stark is 1114343985. It was assigned to this individual provider in the NPPES registry on March 17, 2014.

Where is Kelly Stark located?

Kelly Stark practices at 2705 E 17th St, Ammon, ID 83406. The listed phone number is (208) 346-7500.

What is Kelly Stark's specialty?

The primary specialty registered for this NPI is Social Worker with taxonomy code 104100000X.

Is Kelly Stark enrolled in Medicare?

Yes. Kelly Stark is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Kelly Stark was last updated on November 25, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.