Provider Demographics
NPI:1265455083
Name:CLEAMONS, VINCIENT (RD)
Entity Type:Individual
Prefix:MR
First Name:VINCIENT
Middle Name:
Last Name:CLEAMONS
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 MONTA AVENUE
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403
Mailing Address - Country:US
Mailing Address - Phone:801-597-6007
Mailing Address - Fax:
Practice Address - Street 1:1011 HONOR HEIGHTS DRIVE
Practice Address - Street 2:VA MEDICAL CENTER
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401
Practice Address - Country:US
Practice Address - Phone:918-680-3735
Practice Address - Fax:918-680-3829
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
692977133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered