Provider Demographics
NPI:1164088373
Name:CLEMONS, TERRI KIANDRA
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:KIANDRA
Last Name:CLEMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 ASHLEY AVE STE A
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-7344
Mailing Address - Country:US
Mailing Address - Phone:318-625-7571
Mailing Address - Fax:844-317-5579
Practice Address - Street 1:1715 ASHLEY AVE STE A
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-7344
Practice Address - Country:US
Practice Address - Phone:318-625-7571
Practice Address - Fax:844-317-5579
Is Sole Proprietor?:No
Enumeration Date:2019-05-13
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator