Provider Demographics
NPI:1417666348
Name:CLEMENTS, SASHA MARIE (APRN)
Entity Type:Individual
Prefix:
First Name:SASHA
Middle Name:MARIE
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 S CHURCH ST STE 400
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4112
Mailing Address - Country:US
Mailing Address - Phone:870-935-6012
Mailing Address - Fax:870-934-3156
Practice Address - Street 1:800 S CHURCH ST STE 400
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4112
Practice Address - Country:US
Practice Address - Phone:870-935-6012
Practice Address - Fax:870-934-3156
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR221342363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR222343Medicaid