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

Mr. Kevin S Clark, MMS, PA-C

Individual provider Physician Assistant · NPI 1235370743

Mr. Kevin S Clark, MMS, PA-C is a Physician Assistant in Daytona Beach, Florida. Qualified in 2009, 17 years ago. Accepts Medicare assignment. Licensed in Florida and Illinois.

Years since qualifying
17
Licensed in
FL, IL
In the registry since
2009
Specialties on file
3
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

See every abbreviation used in this directory →

Claim this listing Report a problem Suggest an edit

Practice location Address checks out

103 Memorial Medical Pkwy Ste 125
Daytona Beach, FL 32117-5672
Phone: (386) 274-0250
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA9108797 (FL)
Medical Physician Assistant Taxonomy 363AM0700X · Licence 085003431 (IL)
Emergency Medicine Physician Taxonomy 207P00000X · Licence 085003431 (IL)

Record details

NPI number1235370743
Entity typeIndividual (Type 1)
GenderMale
Credentials MMS , PA-C
Sole proprietorNo
NPI enumeratedMarch 12, 2009
Last updated in NPPESMarch 18, 2026
Certification dateMarch 18, 2026

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2009 (17 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Daytona Beach