KELSEY CLARK (NPI# 1972102465) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972102465 |
| Entity Type | Individual |
| Full Name | KELSEY CLARK |
| Practice Address |
1362 W Main St Whitewater WI 53190-1504 |
| Practice Telephone | 2624737740 |
| Mailing Telephone | 2624737740 |
| Enumeration Date | 2020-10-26 |
| Last Update Date | 2020-10-26 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 183500000X | Pharmacist | 17484 | WI | Pharmacy Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215489307 | Kelsey Ann Clark | Spec/Tech, Cardiovascular | 13 Indian Ridge Rd, New Milford, CT 06776-4614 | 2016-10-25 |
| 1205193984 | Kelsey Nicole Clark | Counselor | 400 S Jefferson St Ste 200, Spokane, WA 99204-3143 | 2012-04-18 |
| 1174124374 | Kelsey Clark | Social Worker | 1865 N Ridge Rd E, Lorain, OH 44055-3300 | 2020-11-04 |
| 1063010312 | Kelsey Leigh-ann Clark | Nurse Practitioner | 10939 Al Highway 157, Moulton, AL 35650-1914 | 2020-10-09 |
| 1063034593 | Kelsey Ann Clark | Behavioral Analyst | 420 S Jones Blvd, Las Vegas, NV 89107-2658 | 2020-05-06 |
| 1164948337 | Kelsey Anne Clark | Physical Therapy Assistant | 8840 Cypress Waters Blvd Ste 300, Coppell, TX 75019-4630 | 2017-08-18 |
| 1891145520 | Kelsey Clark | Occupational Therapist | 721 N Juniata St, Hollidaysburg, PA 16648-1455 | 2016-06-14 |
| 1144510629 | Kelsey Nichole Clark | Occupational Therapist | 165 Plaza Ct, Kingwood, WV 26537-1653 | 2011-04-18 |
| 1679870604 | Kelsey Lynn Clark | Counselor | 5965 S 900 E, Salt Lake City, UT 84121-1720 | 2011-02-28 |
| Street Address |
1362 W MAIN ST |
| City | WHITEWATER |
| State | WI |
| Zip Code | 53190-1504 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003833153 | Wal-mart Stores East Lp | Durable Medical Equipment & Medical Supplies | 1362 W Main St, Whitewater, WI 53190-1504 | 2006-07-16 |
| 1134727191 | Robert Wimmer | Pharmacist | 1362 W Main St, Whitewater, WI 53190-1504 | 2020-10-13 |
| 1548639784 | Wal-mart Stores East, Lp | Technician/Technologist | 1362 W Main St, Whitewater, WI 53190-1504 | 2015-09-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962908608 | Shannon Bashor | Specialist/Technologist | 907 W Schwager Dr, Whitewater, WI 53190 | 2018-04-02 |
| 1922542695 | Terry Teipner | Counselor | 1173 W Main St Ste B, Whitewater, WI 53190 | 2016-12-14 |
| 1063800100 | Courtney Stefanski | Specialist/Technologist | 900 Schwager Drive, Whitewater, WI 53190 | 2014-12-23 |
| 1275942989 | Courtney Palubicki | Specialist/Technologist | 907 W. Schwager Drive, Whitewater, WI 53190 | 2014-08-06 |
| 1548491087 | Ann Marie Welch | Registered Nurse | 9640 N. County Line Rd, Whitewater, WI 53190 | 2009-07-31 |
| 1780801423 | Marsha Lee Mckinnon | Registered Nurse | 710 Starin Road, Whitewater, WI 53190 | 2007-04-20 |
| 1164599387 | Michael J Kellum | Emergency Medicine | W9575 Homburg Lane, Whitewater, WI 53190 | 2006-11-30 |
| 1861596371 | Brian William Veale | Chiropractor | 543 S Putnam St, Whitewater, WI 53190 | 2006-09-13 |
| 1629508908 | Erin Kae Clark | Specialist/Technologist | 800 W Main St, Williams Center 105g, Whitewater, WI 53190 | 2017-06-19 |
| 1952854150 | Rebecca K Hamman | Nurse Practitioner | 710 W Starin Rd, Whitewater, WI 53190 | 2016-07-25 |
| Find all providers in zip 53190 | ||||
| Taxonomy Code | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134727191 | Robert Wimmer | Pharmacist | 1362 W Main St, Whitewater, WI 53190-1504 | 2020-10-13 |
| 1871120238 | Kevin Niksa | Pharmacist | 1041 W Main St, Whitewater, WI 53190-1616 | 2020-03-25 |
| 1952935223 | Serif Odobasic | Pharmacist | 1041 W Main St, Whitewater, WI 53190-1616 | 2020-02-26 |
| 1609413061 | Marci A Rueter | Pharmacist | 1173 W Main St, Whitewater, WI 53190-1672 | 2019-12-04 |
| 1730745191 | Alana Elsie Everson | Pharmacist | 1173 W Main St, Whitewater, WI 53190-1672 | 2019-05-11 |
| 1538512769 | Jolene Dutcher | Pharmacist | 1041 W Main St, Whitewater, WI 53190-1616 | 2016-07-22 |
| 1578808002 | Sara Hathaway | Pharmacist | 1173 W Main St, Whitewater, WI 53190-1672 | 2012-12-10 |
| 1730435157 | Danny Ray Reynolds | Pharmacist | 1041 W Main St, Whitewater, WI 53190-1616 | 2012-08-03 |
| 1366728941 | Robert L Hamilton | Pharmacist | 1041 W Main St, Whitewater, WI 53190-1616 | 2011-10-27 |
| 1740490739 | Robert Mccullough | Pharmacist | 1173 W Main St, Whitewater, WI 53190-1672 | 2007-05-22 |
| Find all providers in WHITEWATER | ||||
| City | WHITEWATER |
| Zip Code | 53190 |
Please comment or provide details below to improve the information on KELSEY CLARK.
| 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.