Kelly Ann Clark, - Medicare Nurse Practitioner in Bethany, MO

  1. Home
  2. Nurse Practitioner
  3. MO
  4. Bethany
Kelly Ann Clark, is a medicare enrolled "Nurse Practitioner - Family" in Bethany, Missouri. Her current practice location is 3202 Miller St, Bethany, Missouri. You can reach out to her office (for appointments etc.) via phone at (660) 425-3154.

Kelly Ann Clark is licensed to practice in Missouri (license number 2020000768) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1164062972.

Contact Information

Kelly Ann Clark,
3202 Miller St,
Bethany, MO 64424-2713
(660) 425-3154
(660) 425-6663

Map and Direction




Provider's Profile

Full NameKelly Ann Clark
GenderFemale
SpecialityNurse Practitioner - Family
Location3202 Miller St, Bethany, Missouri
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1164062972
  • Provider Enumeration Date: 01/09/2020
  • Last Update Date: 03/18/2021
  Medicare PECOS Information:
  • PECOS PAC ID: 7911335864
  • Enrollment ID: I20200309000271

Medical Identifiers

Medical identifiers for Kelly Ann Clark such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1164062972NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
363LF0000XNurse Practitioner - Family 2020000768 (Missouri)Primary
207Q00000XFamily Medicine 2020000768 (Missouri)Secondary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Kelly Ann Clark allows following entities to bill medicare on her behalf.
Entity NameHarrison County Community Hospital District
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1154645745
PECOS PAC ID: 4587630926
Enrollment ID: O20040907001047

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Kelly Ann Clark is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Kelly Ann Clark,
3202 Miller St,
Bethany, MO 64424-2713

Ph: (660) 425-3154		Kelly Ann Clark,
3202 Miller St,
Bethany, MO 64424-2713

Ph: (660) 425-3154

Reviews and Comments


Nurse Practitioner Nurses in Bethany, MO

Mr. Cephas Paniamogan, FNP-C
Nurse Practitioner
Medicare: Medicare Enrolled
Practice Location: 3202 Miller St, Bethany, MO 64424
Phone: 660-425-3154    
Amy B Harris,
Nurse Practitioner
Medicare: Not Enrolled in Medicare
Practice Location: 3202 Miller St, Bethany, MO 64424
Phone: 660-425-3154    Fax: 660-425-6663
Ashley Harding,
Nurse Practitioner
Medicare: Medicare Enrolled
Practice Location: 3202 Miller St, Bethany, MO 64424
Phone: 660-425-3154    Fax: 660-425-6663

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.