Provider Demographics
NPI:1225753619
Name:CLEMONS, MEGAN TANIA (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:TANIA
Last Name:CLEMONS
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4190 GERSTNER MEMORIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70607-3804
Mailing Address - Country:US
Mailing Address - Phone:318-625-6250
Mailing Address - Fax:
Practice Address - Street 1:4190 GERSTNER MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70607-3804
Practice Address - Country:US
Practice Address - Phone:337-240-9730
Practice Address - Fax:337-279-1712
Is Sole Proprietor?:No
Enumeration Date:2022-10-07
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LARN160581163W00000X
LA227601363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse