Provider Demographics
NPI:1063036937
Name:CLEMENT, KAREN REBECCA (PA)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:REBECCA
Last Name:CLEMENT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2490 S WOODWORTH LOOP
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-7410
Mailing Address - Country:US
Mailing Address - Phone:907-861-6315
Mailing Address - Fax:
Practice Address - Street 1:2490 S WOODWORTH LOOP
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-7410
Practice Address - Country:US
Practice Address - Phone:907-861-6315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-05
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK168500363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical