Provider Demographics
NPI:1679579601
Name:CLEMONS, LINDA LOUISE (MSN, CRNP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:LOUISE
Last Name:CLEMONS
Suffix:
Gender:F
Credentials:MSN, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 OLD NATIONAL PIKE
Mailing Address - Street 2:
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15333-2114
Mailing Address - Country:US
Mailing Address - Phone:724-632-6801
Mailing Address - Fax:724-632-6312
Practice Address - Street 1:37 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-4062
Practice Address - Country:US
Practice Address - Phone:724-223-1067
Practice Address - Fax:724-223-1088
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2024-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP003789B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007288440104Medicaid
PA01582OtherHIGHMARK BLUE SHIELD
PA014582OtherHGSA
PA391902OtherNATIONAL GOVERNMENT SERVICES