Kelly O'brian Clark (NPI# 1811086903, PAC ID# 0143416677) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is NURSE PRACTITIONER.
| Nation Provider ID (NPI) | 1811086903 |
| PAC ID by PECOS | 0143416677 |
| Professional Enrollment ID | I20101123000995 |
| Full Name | Kelly O'brian Clark |
| Organization Legal Name | LAPORTE COUNTY COMPREHENSIVE MENTAL HEALTH COUNCIL |
| Address |
7224 W 400 Michigan City IN 46360-2903 |
| Phone Number | 2198794621 |
| Gender | M |
| Graduation Year | 1996 |
| Primary Specialty | NURSE PRACTITIONER |
| Group Practice PAC ID | 3274703046 |
| Number of Group Practice Members | 11 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 150015 | FRANCISCAN ST ANTHONY HEALTH - MICHIGAN CITY |
| 150006 | LA PORTE HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 7224 W 400, Michigan City, IN 46360-2903 | 2198794621 | LAPORTE COUNTY COMPREHENSIVE MENTAL HEALTH COUNCIL |
| Organization Legal Name | LAPORTE COUNTY COMPREHENSIVE MENTAL HEALTH COUNCIL |
| Physicians | 20 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Earle C Titus | Psychologist, Clinical | Laporte County Comprehensive Mental Health Council | 7224 W 400, Michigan City, IN 46360-2903 |
| Juliette Greenberg | Clinical Social Worker | Laporte County Comprehensive Mental Health Council | 7224 W 400, Michigan City, IN 46360-2903 |
| Perry Minner | Clinical Social Worker | Laporte County Comprehensive Mental Health Council | 7224 W 400, Michigan City, IN 46360-2903 |
| Tamara A Macharaschwili | Clinical Social Worker | Laporte County Comprehensive Mental Health Council | 7224 W 400, Michigan City, IN 46360-2903 |
| Sajja L Babu | Psychiatry | Laporte County Comprehensive Mental Health Council | 7224 W 400, Michigan City, IN 46360-2903 |
| Cheryl G Spence | Clinical Social Worker | Laporte County Comprehensive Mental Health Council | 7224 W 400, Michigan City, IN 46360-2903 |
| Samantha M Grooms | Clinical Social Worker | Laporte County Comprehensive Mental Health Council | 7224 W 400, Michigan City, IN 46360-2903 |
| Nichole Semala | Clinical Social Worker | Laporte County Comprehensive Mental Health Council | 7224 W 400, Michigan City, IN 46360-2903 |
| Ephphatha Malden | Clinical Social Worker | Laporte County Comprehensive Mental Health Council | 7224 W 400, Michigan City, IN 46360-2903 |
| Kumud Aggarwal | Psychiatry | Laporte County Comprehensive Mental Health Council | 7224 W 400, Michigan City, IN 46360-2903 |
| Street Address |
7224 W 400 |
| City | MICHIGAN CITY |
| State | IN |
| Zip | 46360-2903 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Earle C Titus | Psychologist, Clinical | Laporte County Comprehensive Mental Health Council | 7224 W 400, Michigan City, IN 46360-2903 |
| Juliette Greenberg | Clinical Social Worker | Laporte County Comprehensive Mental Health Council | 7224 W 400, Michigan City, IN 46360-2903 |
| Perry Minner | Clinical Social Worker | Laporte County Comprehensive Mental Health Council | 7224 W 400, Michigan City, IN 46360-2903 |
| Tamara A Macharaschwili | Clinical Social Worker | Laporte County Comprehensive Mental Health Council | 7224 W 400, Michigan City, IN 46360-2903 |
| Sajja L Babu | Psychiatry | Laporte County Comprehensive Mental Health Council | 7224 W 400, Michigan City, IN 46360-2903 |
| Cheryl G Spence | Clinical Social Worker | Laporte County Comprehensive Mental Health Council | 7224 W 400, Michigan City, IN 46360-2903 |
| Samantha M Grooms | Clinical Social Worker | Laporte County Comprehensive Mental Health Council | 7224 W 400, Michigan City, IN 46360-2903 |
| Nichole Semala | Clinical Social Worker | Laporte County Comprehensive Mental Health Council | 7224 W 400, Michigan City, IN 46360-2903 |
| Ephphatha Malden | Clinical Social Worker | Laporte County Comprehensive Mental Health Council | 7224 W 400, Michigan City, IN 46360-2903 |
| Kumud Aggarwal | Psychiatry | Laporte County Comprehensive Mental Health Council | 7224 W 400, Michigan City, IN 46360-2903 |
| Find all physicians in the same address | |||
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Amanpreet Kaur | Pulmonary Disease | Franciscan Physician Network | 3500 N Franciscan Way, Suite 400, Michigan City, IN 46360-0021 |
| Vidya S Kora | Internal Medicine | Franciscan Physician Network | 3500 Franciscan Way, Michigan City, IN 46360-0021 |
| Brian Paul Dickover | Pulmonary Disease | Franciscan Physician Network | 3500 Franciscan Way, Suite 400, Michigan City, IN 46360-0021 |
| Jennifa K Thomas | Nurse Practitioner | Franciscan Physician Network | 3500 Franciscan Way, Michigan City, IN 46360-0021 |
| Paul W Cheng | Cardiovascular Disease (cardiology) | Franciscan Physician Network | 3500 Franciscan Way, Michigan City, IN 46360-0021 |
| Stan Tovsky | Anesthesiology | Lakeshore Interventional Pain Associates, LLC | 3500 Franciscan Way, Michigan City, IN 46360-0021 |
| Olusola O Ogundipe | Hematology/oncology | Franciscan Physician Network | 3500 Franciscan Way, Michigan City, IN 46360-0021 |
| Syed R Majid | Hospitalist | Franciscan Physician Network | 3500 Franciscan Way, Michigan City, IN 46360-0021 |
| Peter A. Zack | Emergency Medicine | Epmg of Indiana PC | 3500 Franciscan Way, Michigan City, IN 46360-0021 |
| Charles Cooper | Certified Registered Nurse Anesthetist (crna) | La Porte County Anesthesia Associates, LLC | 3500 Franciscan Way, Michigan City, IN 46360-0021 |
| Find all physicians in zip 46360 | |||
| City | MICHIGAN CITY |
| Zip Code | 46360 |
| Specialty | NURSE PRACTITIONER |
| City + Specialty | MICHIGAN CITY + NURSE PRACTITIONER |
Please comment or provide details below to improve the information on Kelly O'brian Clark.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.