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

Kelly Ann Clark, FNP

Individual provider Nurse Practitioner · NPI 1861026650

Kelly Ann Clark, FNP is a Nurse Practitioner in Saint Louis, Missouri. Qualified in 2017, 9 years ago. Practices with Canyon Healthcare Inc, an 11-clinician group and accepts Medicare assignment. Licensed in Missouri.

Years since qualifying
9
Licensed in
MO
In the registry since
2020
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

4590 Childrens Pl
Saint Louis, MO 63110-1020
Phone: (314) 747-5000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence 2018011505 (MO)

Record details

NPI number1861026650
Entity typeIndividual (Type 1)
GenderFemale
Credentials FNP
Sole proprietorNo
NPI enumeratedMarch 2, 2020
Last updated in NPPESMarch 2, 2020
Certification dateMarch 2, 2020

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2017 (9 years in practice)
Group practice Canyon Healthcare Inc — 11 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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