Provider Demographics
NPI:1437440039
Name:KLEMENT, POLLY ANNA (NP)
Entity Type:Individual
Prefix:
First Name:POLLY
Middle Name:ANNA
Last Name:KLEMENT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 647
Mailing Address - Street 2:
Mailing Address - City:MUENSTER
Mailing Address - State:TX
Mailing Address - Zip Code:76252-0647
Mailing Address - Country:US
Mailing Address - Phone:940-759-2502
Mailing Address - Fax:940-759-3608
Practice Address - Street 1:801 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76240-3573
Practice Address - Country:US
Practice Address - Phone:940-612-8560
Practice Address - Fax:940-665-0209
Is Sole Proprietor?:No
Enumeration Date:2011-04-29
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX716516363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner