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

Kilmeny Clark

Individual provider Physician Assistant · NPI 1104443258

Kilmeny Clark is a Physician Assistant in Bloomington, Illinois. Qualified in 2020, 6 years ago. Practices with Carle West Physician Group Inc, a 285-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Illinois and Wisconsin.

Years since qualifying
6
Licensed in
IL, WI
In the registry since
2020
Specialties on file
2
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Practice location Address checks out

3024 E Empire St
Bloomington, IL 61704-5402
Phone: (309) 556-7556
Fax: (309) 556-7551
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 300 W Oak St, Carbondale, IL 62901-1400 — (618) 453-8850

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 085.008097 (IL)
Physician Assistant Taxonomy 363A00000X · Licence 5318-23 (WI)

Record details

NPI number1104443258
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedJuly 5, 2020
Last updated in NPPESJune 9, 2025
Certification dateMay 21, 2025
Mailing address611 W Park St, Fapc, Urbana, IL 61801-2500

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Carle West Physician Group Inc — 285 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations5 on file with Medicare

Other providers in Bloomington