Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Kimberly Nicole Clark, MMS, PA-C

Individual provider Physician Assistant · NPI 1720624166

Kimberly Nicole Clark, MMS, PA-C is a Physician Assistant in Elgin, Illinois. Qualified in 2019, 7 years ago. Practices with Derick Dermatology PLLC, a 64-clinician group and accepts Medicare assignment. Licensed in Illinois.

Years since qualifying
7
Licensed in
IL
In the registry since
2019
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

1600 N Randall Rd Ste 400
Elgin, IL 60123-7805
Phone: (847) 381-8899
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 085.007399 (IL)

Record details

NPI number1720624166
Entity typeIndividual (Type 1)
GenderFemale
Credentials MMS , PA-C
Sole proprietorNo
NPI enumeratedNovember 20, 2019
Last updated in NPPESDecember 16, 2021
Certification dateDecember 16, 2021

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Derick Dermatology Pllc — 64 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations5 on file with Medicare

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