Provider Demographics
NPI:1407588403
Name:CLEM, ALICIA JANELLE (LPN)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:JANELLE
Last Name:CLEM
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 N LEMON ST
Mailing Address - Street 2:
Mailing Address - City:BEEBE
Mailing Address - State:AR
Mailing Address - Zip Code:72012-2730
Mailing Address - Country:US
Mailing Address - Phone:501-286-3245
Mailing Address - Fax:
Practice Address - Street 1:502 RICHIE RD
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-3309
Practice Address - Country:US
Practice Address - Phone:501-941-0940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARL050380164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse