Provider Demographics
NPI:1437746138
Name:CLEMENTS, ASHLEY TATUM
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:TATUM
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4720 HERITAGE DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27712-2508
Mailing Address - Country:US
Mailing Address - Phone:919-698-6368
Mailing Address - Fax:
Practice Address - Street 1:3573 HILLSBOROUGH RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-2916
Practice Address - Country:US
Practice Address - Phone:919-383-0171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC233059163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse