Provider Demographics
NPI:1851305874
Name:CLEMENTS, JOANNA BUNDRUM (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:BUNDRUM
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4108 WATERMELON RD
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35473-5130
Mailing Address - Country:US
Mailing Address - Phone:205-366-9898
Mailing Address - Fax:205-366-9896
Practice Address - Street 1:4108 WATERMELON RD
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35473-5130
Practice Address - Country:US
Practice Address - Phone:205-366-9898
Practice Address - Fax:205-366-9896
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-039155363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0000051551042Medicaid
AL51505432OtherBCBS
ALP40842Medicare UPIN
AL051551042Medicare ID - Type Unspecified