Provider Demographics
NPI:1558920165
Name:FOKAM, CLEMENTINE BI (NP)
Entity Type:Individual
Prefix:
First Name:CLEMENTINE
Middle Name:BI
Last Name:FOKAM
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 1:21610 STATFIELD GLEN CT
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-5674
Mailing Address - Country:US
Mailing Address - Phone:281-763-5464
Mailing Address - Fax:
Practice Address - Street 1:21610 STATFIELD GLEN CT
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-5674
Practice Address - Country:US
Practice Address - Phone:281-763-5464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-07
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30280363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX672392OtherSTATE LICENSE