DR. KELLY RAE CLARK (NPI# 1003071150) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003071150 |
| Entity Type | Individual |
| Full Name | DR. KELLY RAE CLARK |
| Credential | PHARM.D. |
| Practice Address |
130 W Kingsbridge Rd Bronx NY 10468-3904 |
| Practice Telephone | 7185849000 |
| Enumeration Date | 2008-07-28 |
| Last Update Date | 2008-07-28 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1835P1300X |
Pharmacist Specialization: Psychiatric |
41224 | TX | Pharmacy Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861026650 | Kelly Ann Clark | Nurse Practitioner | 4590 Childrens Pl, Saint Louis, MO 63110-1020 | 2020-03-02 |
| 1013474410 | Kelly Patricia Clark | Licensed Practical Nurse | 55 Pine Dr E, Mason, MI 48854-9229 | 2019-02-22 |
| 1013497304 | Kelly Ann Clark | Case Manager/Care Coordinator | 2498 Wenona Dr, Wixom, MI 48393-2199 | 2018-08-16 |
| 1407336720 | Kelly Elizabeth Clark | Physical Medicine & Rehabilitation | 3800 Reservoir Rd., Bles Building, Ground Floor, Department of Pm&r, Washington, DC 20007-2113 | 2018-08-16 |
| 1356747448 | Kelly Clark | Dietitian, Registered | 46 Mallards Cv, Duxbury, MA 02332-3548 | 2014-11-17 |
| 1568883312 | Kelly Clark | Licensed Practical Nurse | 125 W Bartlette St, Apt. 110, Sumter, SC 29150-5173 | 2013-12-20 |
| 1306105903 | Kelly Thomas Clark | Speech-Language Pathologist | 3406 Fowler Ct, Missouri City, TX 77459-6366 | 2012-05-16 |
| 1619247509 | Kelly Jane Clark | Pharmacist | 328 Quail Walk Trl, Chapin, SC 29036-9791 | 2012-01-09 |
| 1427350461 | Kelly Darlene Clark | Chiropractor | 2425 Mahan Dr, Tallahassee, FL 32308-2301 | 2010-11-24 |
| 1538479324 | Kelly S Clark | Licensed Vocational Nurse | 15716 W High St # 597, Middlefield, OH 44062-9201 | 2010-10-14 |
| Street Address |
130 W KINGSBRIDGE RD |
| City | BRONX |
| State | NY |
| Zip Code | 10468-3904 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811991185 | Solomon Nadler | Dentist | 130 W Kingsbridge Rd, Bronx, NY 10468-3904 | 2005-06-02 |
| 1124628755 | Eka Beriashvili | Pharmacist | 130 W Kingsbridge Rd, Bronx, NY 10468-3904 | 2020-11-01 |
| 1578170528 | Luisa Mejia | Radiology | 130 W Kingsbridge Rd, Bronx, NY 10468-3904 | 2020-09-24 |
| 1881208148 | Christina Heng | Nurse Practitioner | 130 W Kingsbridge Rd, Bronx, NY 10468-3904 | 2020-09-03 |
| 1629687710 | Maria Kyritsi | Student in an Organized Health Care Education/Training Program | 130 W Kingsbridge Rd, Bronx, NY 10468-3904 | 2020-07-24 |
| 1013525336 | Adam Adam | Student in an Organized Health Care Education/Training Program | 130 W Kingsbridge Rd, Bronx, NY 10468-3904 | 2020-07-22 |
| 1700494267 | Vaishali Geedigunta | Student in an Organized Health Care Education/Training Program | 130 W Kingsbridge Rd, Bronx, NY 10468-3904 | 2020-07-21 |
| 1134737786 | Gavro Jelic | Student in an Organized Health Care Education/Training Program | 130 W Kingsbridge Rd, Bronx, NY 10468-3904 | 2020-07-20 |
| 1255959664 | Mirjana Barjaktarovic | Student in an Organized Health Care Education/Training Program | 130 W Kingsbridge Rd, Bronx, NY 10468-3904 | 2020-07-12 |
| 1124645171 | Olivia Castro | Respiratory Therapist, Registered | 130 W Kingsbridge Rd, Bronx, NY 10468-3904 | 2020-06-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922623776 | Michalis Georgiou | Student in an Organized Health Care Education/Training Program | 130 W. Kongsbridge Road James J. Petters Vamc, Room: 7a-11, Bronx, NY 10468 | 2020-06-08 |
| 1184248072 | Sindhuja Dogga | Student in an Organized Health Care Education/Training Program | James J Peters Vamc, 130 W Kingsbridge Road, Bronx, NY 10468 | 2020-06-05 |
| 1154945434 | Ambreen Shahzadi | Student in an Organized Health Care Education/Training Program | James J. Peters Vamc, 130 W. Kingsbridge Road (111) Room No. 7a-11, Bronx, NY 10468 | 2020-06-03 |
| 1912521550 | Zara Idrees | Student in an Organized Health Care Education/Training Program | 130 W Kingsbridge Road Room No: 7a-11, Internal Medicin, Bronx, NY 10468 | 2020-05-29 |
| 1710531256 | Ana Samely Maria | Registered Nurse | 2525 Aqueduct Ave B3, Bronx, NY 10468 | 2019-08-01 |
| 1114496007 | Rachel A Squillante | Speech-Language Pathologist | 2280 Aqueduct Avenue, Bronx, NY 10468 | 2018-11-20 |
| 1528547312 | Norwood Professional Medical Services of New York LLC | Surgery | 3487-89 Jerome Ave, Ste A, Bronx, NY 10468 | 2018-08-13 |
| 1336628130 | Norwood Medical of New York LLC | Surgery | 3487-89 Jerome Ave, Ste B, Bronx, NY 10468 | 2018-08-13 |
| 1811473721 | Okyeniba Medical PC | Pediatrics | 58 East Kingsbridge Road, Bronx, NY 10468 | 2018-07-13 |
| 1417446840 | Amina Khalid | Student in an Organized Health Care Education/Training Program | 130 W Kingsbridge Rd., Bronx, NY 10468 | 2018-05-01 |
| Find all providers in zip 10468 | ||||
| Taxonomy Code | 1835P1300X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| Specialization | Psychiatric |
| A licensed pharmacist who has demonstrated specialized knowledge and skill in optimizing care of patients with psychiatric illness by assessing and monitoring patients, recognizing drug-induced problems, and recommending appropriate treatment plans. |
| Notes: Source: Specialty certification and recertification program administered by Board of Pharmaceutical Specialties, www.bpsweb.org [7/1/2006: modified title, added definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295966752 | Bessman Uzoma Iheanyi | Pharmacist | 1276 Fulton Ave, Bronx, NY 10456-3402 | 2009-08-01 |
| 1881658607 | Alice B Lee | Pharmacist | 130 W Kingsbridge Rd, Bronx, NY 10468-3904 | 2006-04-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982030417 | Lisa Stetson | Pharmacist | 777 Seaview Avenue South Beach Psychiatric Center, Staten Island, NY 10305-3409 | 2013-09-16 |
| 1366680936 | Wing Dave Fai Mui | Pharmacist | 2596 E 26th St, Brooklyn, NY 11235-2418 | 2009-02-04 |
| 1215172556 | Nisha Franklin Thomas | Pharmacist | 79 Phillips Hill Rd, New City, NY 10956-4113 | 2008-12-15 |
| 1457502601 | Ronald Andre Lombino | Pharmacist | 79-25 Winchester Blvd, Queens Village, NY 11427-2147 | 2008-10-07 |
| 1619182847 | Jane Sundberg | Pharmacist | 601 Elmwood Box 638, Rochester, NY 14642-1228 | 2007-05-11 |
| 1659592210 | Tammie Lee M Demler | Pharmacist | 400 Forest Avenue, Buffalo, NY 14213 | 2007-05-01 |
| 1174655518 | Foster D Myers IIi | Pharmacist | 625 Madison St, Syracuse, NY 13210 | 2007-03-12 |
| 1134126311 | Sudha Narayanaswamy | Pharmacist | 585 Schenectady Ave, Brooklyn, NY 11203-1809 | 2005-07-05 |
| 1457826653 | Gerard Patrick Quinn | Pharmacist | 462 1st Ave, New York, NY 10016-9196 | 2018-10-04 |
| 1396197992 | Gary Sweet | Pharmacist | 3495 Bailey Ave, Buffalo, NY 14215-1129 | 2016-07-07 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.