Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Bethany Kristin Clark, FNP

Individual provider Family Nurse Practitioner · NPI 1639953433

Bethany Kristin Clark, FNP is a Nurse Practitioner in Fullerton, California. Qualified in 2022, 4 years ago. Practices with Providence Medical Foundation, a 1,465-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in California.

Years since qualifying
4
Licensed in
CA
In the registry since
2023
What do these letters mean?
FNP — Family Nurse Practitioner
A nurse practitioner who treats patients of all ages, much like a family doctor.

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Practice location Address checks out

101 Laguna Rd Ste 200
Fullerton, CA 92835-3601
Phone: (714) 992-5350
Fax: (714) 446-5539
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 706 Park Shadow Ct, Baldwin Park, CA 91706-3266 — (626) 589-0481

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 95026372 (CA)

Record details

NPI number1639953433
Entity typeIndividual (Type 1)
GenderFemale
Credentials FNP
Sole proprietorYes
NPI enumeratedAugust 22, 2023
Last updated in NPPESJune 17, 2026
Certification dateJune 17, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Providence Medical Foundation — 1465 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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