Provider Demographics
NPI:1558903260
Name:CLEMONS, KRISTELLE ALIE (FNP)
Entity Type:Individual
Prefix:
First Name:KRISTELLE
Middle Name:ALIE
Last Name:CLEMONS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1196 COUNTRY GARDENS LN
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34982-3327
Mailing Address - Country:US
Mailing Address - Phone:772-370-5250
Mailing Address - Fax:
Practice Address - Street 1:1196 COUNTRY GARDENS LN
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34982-3327
Practice Address - Country:US
Practice Address - Phone:772-370-5250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-14
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11003696363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily