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

Kelly Stark

Individual provider Social Worker · NPI 1114343985

Kelly Stark is a Clinical Social Worker in Ammon, Idaho. Qualified in 2011, 15 years ago. Licensed in Idaho.

Years since qualifying
15
Licensed in
ID
In the registry since
2014
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Practice location Address checks out

2705 E 17th St
Ammon, ID 83406-6669
Phone: (208) 346-7500
Fax: (208) 346-7501
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Social Worker (primary) Taxonomy 104100000X · Licence LMSW-33495 (ID)

Record details

NPI number1114343985
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedMarch 17, 2014
Last updated in NPPESNovember 25, 2025
Certification dateNovember 25, 2025
Mailing address2705 E 17th St, Ammon, ID 83406-6669

Medicare enrollment

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

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2011 (15 years in practice)
Accepts Medicare assignment Not indicated

Other providers in Ammon