Provider Demographics
NPI:1578797650
Name:CLEMENTS, KELLY EILEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:EILEEN
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KELLY
Other - Middle Name:EILEEN
Other - Last Name:GLOOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1600 WALLACE BLVD
Mailing Address - Street 2:NICU
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1799
Mailing Address - Country:US
Mailing Address - Phone:806-212-6428
Mailing Address - Fax:
Practice Address - Street 1:1600 WALLACE BLVD
Practice Address - Street 2:NICU
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1799
Practice Address - Country:US
Practice Address - Phone:806-212-6428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ36552080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
62835OtherALBANY MEDICAL CENTER