MR. KELLY O'BRIAN CLARK R.N., M.S.N., F.N.P.
NPI 1811086903
Nurse Practitioner - Adult Health in Knox, IN

Q: What is Kelly Clark's NPI number?

The NPI number for Kelly Clark is 1811086903. It was assigned to this individual provider in the NPPES registry on October 12, 2006.

Q: What is Kelly Clark's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Adult Health, with taxonomy code 363LA2200X.

Q: When was this NPI record last updated?

The NPPES record for Kelly Clark was last updated on July 8, 2007. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since October 12, 2006PECOS EnrolledAccepts Medicare Assignment

1002 S EDGEWOOD DR, KNOX, IN 46534(574) 772-6030(574) 772-7494 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: July 26, 2026.

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About Mr. Kelly O'brian Clark R.n., M.s.n., F.n.p. NPPES

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

MR. KELLY O'BRIAN CLARK R.N., M.S.N., F.N.P. (NPI 1811086903) is an individual adult health provider in Knox, Indiana, licensed in Indiana (71000435A) and active in the NPI registry since October 2006. He is enrolled in Medicare PECOS and is a graduate of Other (1996).

NPPES Registry Identity

NPI1811086903

Entity TypeIndividualMale

Primary Taxonomy363LA2200X

Provider Legal NameMR. KELLY O'BRIAN CLARKCredential: R.N., M.S.N., F.N.P.

Location Address1002 S EDGEWOOD DRKnox, IN 46534-8226

Mailing Address1002 S Edgewood DrKnox, IN 46534-8226 · (574) 772-6030 · Fax (574) 772-7494

Phone(574) 772-6030

Fax(574) 772-7494

Sole ProprietorNo

Medical School CMSOtherGraduated 1996

Enumeration DateOctober 12, 2006

Last NPPES UpdateJuly 8, 2007

✔ NPI 1811086903 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Adult HealthPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LA2200X

License✔ Licensed in IN · 71000435A

1002 S EDGEWOOD DR, Knox, IN 46534

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Other Identifiers 2

Medicare ID-Type Unspecified760990DIN

Medicare UPINP80555IN

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Meridian, Ambetter Health and more.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

Mr. Kelly O'brian Clark R.n., M.s.n., F.n.p. 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 ID143416677

PECOS Enrollment IDI20101123000995

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.

Areas of Expertise CMS Part B claims 2

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

520 services85 patients

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

12 services12 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 46534 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

$82.04 typical visit price

range $53.07 – $161.76

Typical copayment $20.51 (range $13.26 – $40.44)

Most-billed visit code 99203

Established Patient

$94.22 typical visit price

range $16.93 – $132.22

Typical copayment $23.55 (range $4.23 – $33.05)

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.

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Other Providers at the Same Location NPPES 5

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

MRS. LESLEY AMBER METTS MSN, FNP

Nurse Practitioner (Family)