Question 1

What type of a medical provider is Kelly Clark?

Accepted Answer

Kelly Clark is a Nurse Practitioner.

Question 2

Where does Kelly Clark practice medicine?

Accepted Answer

Kelly Clark has the following practice address:11134 BROAD RIVER RD STE D, IRMO, SC 29063-7616

Question 3

Does this provider have a license number?

Accepted Answer

Kelly Clark has the following license number: License Number 25865 issued in South Carolina.

Question 4

Does Kelly Clark accept Medicare?

Accepted Answer

We do not know if this provider accepts the Medicare-approved amount.

Question 5

Does Kelly Clark have any board certifications?

Accepted Answer

The provider does not have any board certifications.

Question 6

Is Kelly Clark a member of any Medical Groups?

Accepted Answer

Kelly Clark is not affiliated with any medical groups.

Question 7

Does Kelly Clark participate in PECOS?

Accepted Answer

Yes, Kelly Clark participates in PECOS.

Question 8

What phone number can I call to contact Kelly Clark?

Accepted Answer

You can call the following number: (803)-732-0920

Question 9

Are there any exclusions against this provider?

Accepted Answer

We have not detected any Exclusions tied directly to Kelly Clark.

Question 10

Is Kelly Clark  affiliated with any hospitals?

Accepted Answer

The provider is not affiliated with any hospitals.

Question 11

When was this information last updated?

Accepted Answer

The CMS-based NPPES information was updated approximately 3 years ago (3/7/2022).

Taxonomy	State	Primary?
Nurse Practitioner - Taxonomy Code 363L00000X	SC	Y
Student - Taxonomy Code 390200000X	--	N

Participates in PECOS:	YES
PECOS Individual Enrollment ID:
PECOS Individual PAC ID:
Eligible to order/refer Part B Clinical Laboratory and Imaging	Yes
Eligible to order/refer Durable Medical Equipment (DME)	Yes
Eligible to order/refer Home Health Agency (HHA)	Yes
Eligible to order/refer Power Mobility Devices (PMD)	Yes

Kelly Clark

Overview