Kelley Nichola Clark, CRNA in Lawrenceville, GA - Medicare Certified Registered Nurse Anesthetist (crna)

Kelley Nichola Clark, CRNA is a medicare enrolled "Nurse Anesthetist, Certified Registered" in Lawrenceville, Georgia. She graduated from nursing school in 2008 and has 18 years of diverse experience with area of expertise as Certified Registered Nurse Anesthetist (crna). She is a member of the group practice Johns Hopkins University and her current practice location is 1000 Medical Center Blvd, Lawrenceville, Georgia. You can reach out to her office (for appointments etc.) via phone at (678) 312-1000.

Kelley Nichola Clark is licensed to practice in Maryland (license number R196154) and she also participates in the medicare program. She may accept medicare assignments (which means she may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance) and her NPI Number is 1245652528.

Contact Information

	Kelley Nichola Clark, CRNA
	1000 Medical Center Blvd, Lawrenceville, GA 30046-7694
	(678) 312-1000
	(678) 312-3282

Map and Direction

Provider's Profile

Full Name	Kelley Nichola Clark
Gender	Female
Speciality	Certified Registered Nurse Anesthetist (crna)
Experience	18 Years
Location	1000 Medical Center Blvd, Lawrenceville, Georgia
Accepts Medicare Assignments	May be. She may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance.

Medical Education and Training:

Kelley Nichola Clark graduated from nursing school in 2008

NPI Data:

NPI Number: 1245652528
Provider Enumeration Date: 01/06/2014
Last Update Date: 02/23/2026

Medicare PECOS Information:

PECOS PAC ID: 9830312016
Enrollment ID: I20140515000160

Medical Identifiers

Medical identifiers for Kelley Nichola Clark such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1245652528	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
367500000X	Nurse Anesthetist, Certified Registered	GAA-CRNA004022 (Georgia)	Secondary
367500000X	Nurse Anesthetist, Certified Registered	R196154 (Maryland)	Primary

Medical Facilities Affiliation

Facility Name	Location	Facility Type
Johns Hopkins Hospital, The	Baltimore, MD	Hospital

Group Practice Association

Group Practice Name	Group PECOS PAC ID	No. of Members
Johns Hopkins University	8921903147	2699

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. Kelley Nichola Clark allows following entities to bill medicare on her behalf.

Entity Name	Johns Hopkins University
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1922008549 PECOS PAC ID: 8921903147 Enrollment ID: O20031215000719

Entity Name	Meritus Medical Center Inc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1205176393 PECOS PAC ID: 7113811795 Enrollment ID: O20040212000950

Entity Name	First Colonies Anesthesia Associates, Llc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1740218767 PECOS PAC ID: 8426039744 Enrollment ID: O20040525000119

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. Kelley Nichola 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 Address	Practice Location Address
Kelley Nichola Clark, CRNA 1000 Medical Center Blvd, Lawrenceville, GA 30046-7694 Ph: (678) 312-1000	Kelley Nichola Clark, CRNA 1000 Medical Center Blvd, Lawrenceville, GA 30046-7694 Ph: (678) 312-1000

Reviews and Comments

Nurse Anesthetist, Certified Registered Nurses in Lawrenceville, GA

John G Bojack, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 1000 Medical Center Blvd, Lawrenceville, GA 30046 Phone: 770-277-3056 Fax: 855-204-5244
John D Singleton, CRNA Nurse Anesthetist - CR Medicare: Not Enrolled in Medicare Practice Location: 1000 Medical Center Blvd, Lawrenceville, GA 30046 Phone: 770-277-3056 Fax: 855-204-5244
Mr. Charles Leroy Peacock, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 1000 Medical Center Blvd, Lawrenceville, GA 30045 Phone: 678-442-4321
Dr. Souleymane Kabore, DNP Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 1000 Medical Center Blvd, Lawrenceville, GA 30046 Phone: 678-312-1000
Allison Reinecke Hodge, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 1000 Medical Center Blvd, Lawrenceville, GA 30046 Phone: 770-963-9905
Jennifer D Del Bagno, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 1000 Medical Center Blvd, Lawrenceville, GA 30046 Phone: 770-277-3056 Fax: 855-204-5244
Elizabeth A Walker, CRNA Nurse Anesthetist - CR Medicare: Not Enrolled in Medicare Practice Location: 1000 Medical Center Blvd, Lawrenceville, GA 30046 Phone: 770-277-3056 Fax: 855-204-5244

Kelley Nichola Clark, CRNA - Medicare Certified Registered Nurse Anesthetist (crna) in Lawrenceville, GA