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Deactivated NPI 1043665581 Deactivated / Inactive NPI Female Practitioner

Kelli Clark , PRSS

Peer Specialist • Yukon, OK

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Kelli Clark has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date May 03, 2016
NPI Deactivation Date February 21, 2024
Total Practice Duration ~8 Years of Practice (2016 – 2024)

Professional Overview & Biography Verified Profile Summary

Kelli Clark, PRSS was a registered Peer Specialist practicing in Yukon, OK. Throughout an active medical career spanning 8 years, Kelli Clark provided care at the practice location at 11729 HACKNEY LN until profile deactivation on 2024-02-21.

Practice Location & Contact Primary Location

Practice Address

11729 Hackney Ln

Yukon, OK 730998130

Telephone 4059210341

Specialty Benchmarks & Practice Insights

Comparative analytics for Peer Specialist in Yukon, OK

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 10.2 Yrs
Regional Practice Density
41 Specialists

Practicing in Yukon, OK (5280 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Peer Specialist Primary Specialty

NUCC Taxonomy Code: 175T00000X

Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

1 Associated Practitioners
Mary O'connor

Nurse Practitioner - Family

NPI 1427441401

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

13 Historical Events
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NPI Profile Deactivated February 21, 2024

Record deactivated on February 21, 2024

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Provider Name / Credentials Updated July 18, 2022

Recorded as KELLI MADISON, CM, PRSS, BHWC

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Medical Taxonomy / Specialty Registered (Primary Specialty) June 20, 2022

Health & Wellness Coach (License #4159 in OK)

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Updated Practice Location October 14, 2020

Registered at 4400 N LINCOLN BLVD, OKLAHOMA CITY, OK 731055108 (Tel: 4054247711)

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Updated Business Mailing Address October 14, 2020

Registered at 4400 N LINCOLN BLVD, OKLAHOMA CITY, OK 731055108 (Tel: 4054247711)

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Provider Name / Credentials Updated October 14, 2020

Recorded as KELLI MADISON, PRSS

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Medical Taxonomy / Specialty Registered (Primary Specialty) October 14, 2020

Peer Specialist (License #130404 in OK)

NPI Profile Active May 03, 2016

NPI status registered as active in NPPES database

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Updated Practice Location May 03, 2016

Registered at 11729 HACKNEY LN, YUKON, OK 730998130 (Tel: 4059210341)

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Updated Business Mailing Address May 03, 2016

Registered at 11729 HACKNEY LN, YUKON, OK 730998130 (Tel: 4059219341)

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Provider Name / Credentials Updated May 03, 2016

Recorded as KELLI CLARK, PRSS

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Medical Taxonomy / Specialty Registered (Primary Specialty) May 03, 2016

Peer Specialist

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Initial NPI Registration & Enumeration May 03, 2016

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1043665581
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: May 03, 2016
Last Update: May 03, 2016
Deactivation Date: February 21, 2024

Mailing Address

11729 Hackney Ln

Yukon, OK 730998130

Phone: 4059219341

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.