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KELLY ANN CLARK FNP
NPI 1861026650
Nurse Practitioner in Saint Louis, MO

Active since March 02, 2020PECOS EnrolledAccepts Medicare Assignment
4590 CHILDRENS PL, SAINT LOUIS, MO 63110(314) 747-5000 Get Directions Write a Review

NPPES record last updated: March 2, 2020. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Kelly Ann Clark Fnp NPPES

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

KELLY ANN CLARK FNP (NPI 1861026650) is an individual nurse practitioner in Saint Louis, Missouri, licensed in Missouri (2018011505) and active in the NPI registry since March 2020. She is enrolled in Medicare PECOS and is a graduate of Other (2017).

NPPES Registry Identity

NPI1861026650
Entity TypeIndividualFemale
Primary Taxonomy363L00000X
Provider Legal NameKELLY ANN CLARKCredential: FNP
Location Address4590 CHILDRENS PLSaint Louis, MO 63110-1020
Mailing Address4590 Childrens PlSaint Louis, MO 63110-1020
Phone(314) 747-5000
Sole ProprietorNo
Medical School CMSOtherGraduated 2017
Enumeration DateMarch 2, 2020
NPPES CertifiedMarch 2, 2020
✔ NPI 1861026650 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363L00000X
License✔ Licensed in MO · 2018011505
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.
4590 CHILDRENS PL, Saint Louis, MO 63110
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Molina Healthcare, Select Health.Insurance ›

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

Kelly Ann 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.

PECOS PAC ID7517362692
PECOS Enrollment IDI20250718002989
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.

Medicare Billing Reassignments

2

Medicare enrollment records show Kelly Clark reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Signify Health, LLC
540 mi
General Practice
4055 VALLEY VIEW LN STE 700
Dallas, TX 75244
  • Reassigned Medicare billing, Missouri and Utah enrollments
  • 412 clinicians in this Medicare group
NPI 1689158487 (469) 466-7007
Canyon Healthcare, Inc.
1,159 mi
Multi-Specialty
1916 N 700 W STE 110
Layton, UT 84041
  • Reassigned Medicare billing, Utah enrollment
  • 13 clinicians in this Medicare group
NPI 1649748559 (888) 253-6598

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 63110 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
$86.32 typical visit price
range $55.65 – $169.38
Typical copayment $21.58 (range $13.91 – $42.34)
Most-billed visit code 99203
Established Patient
$98.37 typical visit price
range $17.76 – $137.92
Typical copayment $24.59 (range $4.44 – $34.48)
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 2

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

Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing E0431
DME-Oxygen and Supplies · category DC000N
1 supplier12 claims12 services$21.30 avg. paid by Medicare
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate E1390
DME-Oxygen and Supplies · category DC002N
1 supplier12 claims12 services$119.41 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

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 1861026650. It was assigned to this individual provider in the NPPES registry on March 2, 2020.

Where is Kelly Clark located?

Kelly Clark practices at 4590 Childrens Pl, Saint Louis, MO 63110. The listed phone number is (314) 747-5000.

What is Kelly Clark's specialty?

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

Is Kelly Clark enrolled in Medicare?

Yes. Kelly 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 Kelly Clark's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kelly Clark reassigns Medicare benefits to 2 organizations: Signify Health, LLC (Dallas, TX) and Canyon Healthcare, Inc. (Layton, UT). 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 Kelly Clark's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Kelly Clark accept?

Health plans from Molina Healthcare and Select Health list Kelly Clark as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Kelly Clark was last updated on March 2, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.