Provider Demographics
NPI:1568188605
Name:CLEMENS, KIMBERLY (FNP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:CLEMENS
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 1:3917 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD SHORES
Mailing Address - State:TX
Mailing Address - Zip Code:78657-9463
Mailing Address - Country:US
Mailing Address - Phone:512-968-2903
Mailing Address - Fax:
Practice Address - Street 1:15101 W FM 2147
Practice Address - Street 2:
Practice Address - City:HORSESHOE BAY
Practice Address - State:TX
Practice Address - Zip Code:78657-2168
Practice Address - Country:US
Practice Address - Phone:830-262-0988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-19
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1103901363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily