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

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