Provider Demographics
NPI:1891853685
Name:CLEMANS, DWIGHT RAYMOND (RN FNP)
Entity Type:Individual
Prefix:MR
First Name:DWIGHT
Middle Name:RAYMOND
Last Name:CLEMANS
Suffix:
Gender:M
Credentials:RN FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7914 FM 9 S
Mailing Address - Street 2:
Mailing Address - City:WASKOM
Mailing Address - State:TX
Mailing Address - Zip Code:75692-6428
Mailing Address - Country:US
Mailing Address - Phone:903-633-2405
Mailing Address - Fax:903-935-9102
Practice Address - Street 1:402 S BOLIVAR ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670-4110
Practice Address - Country:US
Practice Address - Phone:903-935-9100
Practice Address - Fax:903-935-9102
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX623027363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00W843OtherMEDICARE GROUP
TX00W843OtherMEDICARE GROUP