KELLY ANN CLARK
NPI 1164062972
Nurse Practitioner - Family in Bethany, MO

Q: What is Kelly Clark's NPI number?

The NPI number for Kelly Clark is 1164062972. It was assigned to this individual provider in the NPPES registry on January 9, 2020.

Q: What is Kelly Clark's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Q: When was this NPI record last updated?

The NPPES record for Kelly Clark was last updated on March 18, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since January 09, 2020PECOS EnrolledAccepts Medicare Assignment

3202 MILLER ST, BETHANY, MO 64424(660) 425-3154(660) 425-6663 Get Directions Write a Review

NPPES record last updated: March 18, 2021. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Mar 18, 2021, Jan 9, 2020 (2 updates tracked since 2020).

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About Kelly Ann Clark NPPES

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

KELLY ANN CLARK (NPI 1164062972) is an individual family provider in Bethany, Missouri, licensed in Missouri (2020000768) and active in the NPI registry since January 2020. She is enrolled in Medicare PECOS, is affiliated with Harrison County Community Hospital, and is a graduate of Other (2019).

NPPES Registry Identity

NPI1164062972

Entity TypeIndividualFemale

Primary Taxonomy363LF0000X

Provider Legal NameKELLY ANN CLARK

Location Address3202 MILLER STBethany, MO 64424-2713

Mailing Address3202 Miller StBethany, MO 64424-2713 · (660) 425-3154

Phone(660) 425-3154

Fax(660) 425-6663

Sole ProprietorNo

Medical School CMSOtherGraduated 2019

Enumeration DateJanuary 9, 2020

Last NPPES UpdateMarch 18, 20212 updates tracked since enumeration

NPPES CertifiedMarch 18, 2021

✔ NPI 1164062972 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

License✔ Licensed in MO · 2020000768

Also ListedFamily MedicineTaxonomy 207Q00000X · License 2020000768 (MO)

3202 MILLER ST, Bethany, MO 64424

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Kansas City, UnitedHealthcare.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Kelly Ann Clark is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID7911335864

PECOS Enrollment IDI20200309000271

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.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Harrison County Community Hospital

Critical Access Hospitals · Bethany, MO

OwnershipGovernment - Hospital District or Authority

CMS Certification Number261312

Location2600 Miller StreetBethany, MO 64424 · Harrison County

Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 64424 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$81.64 typical visit price

range $52.28 – $161.24

Typical copayment $20.41 (range $13.07 – $40.31)

Most-billed visit code 99203

Established Patient

$93.24 typical visit price

range $16.30 – $131.05

Typical copayment $23.31 (range $4.07 – $32.76)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Referred Medical Equipment & Supplies CMS DME claims

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Nebulizer, with compressor E0570

DME-Other DME · category DE000N

1 supplier11 claims11 services$8.52 avg. paid by Medicare

Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 14

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

KIMBERLY BAKER M.D.

Family Medicine