Provider Demographics
NPI:1710020771
Name:CLEMENTS, KRISTINE M (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:M
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:
Other - Last Name:BEDORTHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:888 SWIFT BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352
Mailing Address - Country:US
Mailing Address - Phone:509-942-3627
Mailing Address - Fax:509-942-2268
Practice Address - Street 1:236 E NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-2449
Practice Address - Country:US
Practice Address - Phone:541-567-1137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200650135NP363LF0000X
WAAP30007661363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily