KELLY CLARK
NPI 1639840580
Nurse Practitioner in Irmo, SC

Q: What is Kelly Clark's NPI number?

The NPI number for Kelly Clark is 1639840580. It was assigned to this individual provider in the NPPES registry on September 21, 2021.

Q: What is Kelly Clark's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Q: When was this NPI record last updated?

The NPPES record for Kelly Clark was last updated on March 7, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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 September 21, 2021

11134 BROAD RIVER RD STE D, IRMO, SC 29063(803) 732-0920 Get Directions Write a Review

NPPES record last updated: March 7, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Mar 7, 2022, Sep 21, 2021 (2 updates tracked since 2021).

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About Kelly Clark NPPES

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

KELLY CLARK (NPI 1639840580) is an individual nurse practitioner in Irmo, South Carolina, licensed in South Carolina (25865) and active in the NPI registry since September 2021.

NPPES Registry Identity

NPI1639840580

Entity TypeIndividualFemale

Primary Taxonomy363L00000X

Provider Legal NameKELLY CLARK

Location Address11134 BROAD RIVER RD STE DIrmo, SC 29063-7616

Mailing Address11134 Broad River Rd Ste DIrmo, SC 29063-7616

Phone(803) 732-0920

Sole ProprietorNo

Enumeration DateSeptember 21, 2021

Last NPPES UpdateMarch 7, 20222 updates tracked since enumeration

NPPES CertifiedMarch 7, 2022

✔ NPI 1639840580 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363L00000X

License✔ Licensed in SC · 25865

Definition

(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X

11134 BROAD RIVER RD STE D, Irmo, SC 29063

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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 Clark's NPI number?

The NPI number for Kelly Clark is 1639840580. It was assigned to this individual provider in the NPPES registry on September 21, 2021.

Where is Kelly Clark located?

Kelly Clark practices at 11134 Broad River Rd Ste D, Irmo, SC 29063. The listed phone number is (803) 732-0920.

What is Kelly Clark's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

When was this NPI record last updated?

The NPPES record for Kelly Clark was last updated on March 7, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.