Provider Demographics
NPI:1518944560
Name:CLEARMAN, SELENA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:SELENA
Middle Name:
Last Name:CLEARMAN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7100 U S HIGHWAY 98 STE 140
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-8557
Mailing Address - Country:US
Mailing Address - Phone:601-261-5710
Mailing Address - Fax:601-268-5058
Practice Address - Street 1:7100 U S HIGHWAY 98 STE 140
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402
Practice Address - Country:US
Practice Address - Phone:601-261-5710
Practice Address - Fax:601-268-5058
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR852019363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS11552881OtherCAQH ID NUMBER
MS7684480OtherAETNA
MS00123556Medicaid
MSP00718596OtherRAILROAD MEDICARE
MS00123556Medicaid
MSP82686Medicare UPIN