BETHANY KRISTIN CLARK FNP
NPI 1639953433
Nurse Practitioner - Family in Fullerton, CA
About Bethany Kristin Clark Fnp NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
BETHANY KRISTIN CLARK FNP (NPI 1639953433) is an individual family provider in Fullerton, California, licensed in California (95026372) and active in the NPI registry since August 2023. She is enrolled in Medicare PECOS, maintains a secondary practice location in Baldwin Park, and is a graduate of Other (2022).
NPPES Registry Identity
Specialties & Licenses
Secondary Practice Location 1
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Bethany Kristin Clark Fnp 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.
Medicare Billing Reassignments
2Medicare enrollment records show Bethany Clark reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Brea, CA 92821
- Reassigned Medicare billing, California enrollment
- 1,699 clinicians in this Medicare group
Arcadia, CA 91006
- Reassigned Medicare billing, California enrollment
- 2 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 92835 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
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 Bethany Clark's NPI number?
The NPI number for Bethany Clark is 1639953433. It was assigned to this individual provider in the NPPES registry on August 22, 2023.
Where is Bethany Clark located?
Bethany Clark practices at 101 Laguna Rd Ste 200, Fullerton, CA 92835. The listed phone number is (714) 992-5350.
What is Bethany Clark's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.
Is Bethany Clark enrolled in Medicare?
Yes. Bethany Clark is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organizations bill Medicare for Bethany Clark's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Bethany Clark reassigns Medicare benefits to 2 organizations: Providence Medical Foundation (Brea, CA) and Ob-Gyn Place A Medical Corporation (Arcadia, CA). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Bethany Clark's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Bethany Clark was last updated on June 17, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 months 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.
# Bethany Kristin Clark, FNP · NPI 1639953433
Family physician in Fullerton, California. Individual provider, active in the CMS NPPES registry since August 22, 2023.
## Identity
- **NPI:** 1639953433 (Entity type: Individual)
- **Enumerated:** August 22, 2023
- **Primary specialty:** Nurse Practitioner - Family · taxonomy 363LF0000X
- **State license:** 95026372 (California)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 101 LAGUNA RD STE 200, Fullerton, CA 92835-3601
- **Phone:** (714) 992-5350 · **Fax:** (714) 446-5539
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 2 organizations under Medicare reassignment (form CMS-855R): Providence Medical Foundation (NPI 1871607762, Brea, CA); Ob-Gyn Place A Medical Corporation (NPI 1699786293, Arcadia, CA) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2022
## Record status
- **NPPES last updated:** June 17, 2026
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Source: [NPI Profile](https://npiprofile.com/npi/1639953433) · Data from the CMS NPPES public registry.