Provider Demographics
NPI:1417585837
Name:CLEMENTS, ALEXANDRIA (DO)
Entity Type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2186 N HOSPITAL BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:IN
Mailing Address - Zip Code:47882-7654
Mailing Address - Country:US
Mailing Address - Phone:812-268-4311
Mailing Address - Fax:
Practice Address - Street 1:2186 N HOSPITAL BLVD STE 2
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:IN
Practice Address - Zip Code:47882-7654
Practice Address - Country:US
Practice Address - Phone:812-268-4311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02006690A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine