Kristy Nicole Clark, CRNP is a medicare enrolled "Nurse Practitioner - Family" in Shinglehouse, Pennsylvania. She graduated from nursing school in 2019 and has 6 years of diverse experience with area of expertise as Nurse Practitioner. She is a member of the group practice Charles Cole Memorial Hospital and her current practice location is
129 N Puritan Street, Shinglehouse, Pennsylvania. You can reach out to her office (for appointments etc.) via phone at
(814) 260-9352.
Kristy Nicole Clark is licensed to practice in Pennsylvania (license number SP020957) and she also participates in the medicare program. She
accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1699317578.
Provider's Profile
| Full Name | Kristy Nicole Clark |
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| Gender | Female |
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| Speciality | Nurse Practitioner |
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| Experience | 6 Years |
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| Location | 129 N Puritan Street, Shinglehouse, Pennsylvania |
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| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Kristy Nicole Clark graduated from nursing school in 2019
NPI Data:
- NPI Number: 1699317578
- Provider Enumeration Date: 10/12/2019
- Last Update Date: 10/11/2021
Medicare PECOS Information:
- PECOS PAC ID: 6901237122
- Enrollment ID: I20200504000015
Medical Identifiers
Medical identifiers for Kristy Nicole Clark such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1699317578 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 363LF0000X | Nurse Practitioner - Family | SP020957 (Pennsylvania) | Primary |
Medical Facilities Affiliation
| Facility Name | Location | Facility Type |
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| Upmc Cole | Coudersport, PA | Hospital |
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
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| Charles Cole Memorial Hospital | 3779487475 | 42 |
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. Kristy Nicole Clark allows following entities to bill medicare on her behalf.
| Entity Name | Charles Cole Memorial Hospital |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1326161662
PECOS PAC ID: 3779487475
Enrollment ID: O20040310001269 |
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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. Kristy Nicole 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 |
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Kristy Nicole Clark, CRNP
1001 E 2nd St,
Coudersport, PA 16915-8161
Ph: (814) 274-9300 | Kristy Nicole Clark, CRNP
129 N Puritan Street,
Shinglehouse, PA 16748
Ph: (814) 260-9352 |
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