Provider Demographics
NPI:1417227315
Name:CLEMONS, JESSICA RENEE (NP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:RENEE
Last Name:CLEMONS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2700 TIBBETS DR
Mailing Address - Street 2:STE 500
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-5928
Mailing Address - Country:US
Mailing Address - Phone:817-545-9100
Mailing Address - Fax:817-545-9134
Practice Address - Street 1:2700 TIBBETS DR
Practice Address - Street 2:STE 500
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-5928
Practice Address - Country:US
Practice Address - Phone:817-545-9100
Practice Address - Fax:817-545-9134
Is Sole Proprietor?:No
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX670283363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health