Provider Demographics
NPI:1972865582
Name:CLEMENS, JONATHAN PAUL (DMSC, PA-C)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:PAUL
Last Name:CLEMENS
Suffix:
Gender:M
Credentials:DMSC, PA-C
Other - Prefix:
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Mailing Address - Street 1:PO BOX 5430
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98509-5430
Mailing Address - Country:US
Mailing Address - Phone:360-634-8949
Mailing Address - Fax:360-634-8234
Practice Address - Street 1:3624 ENSIGN RD NE STE F
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5114
Practice Address - Country:US
Practice Address - Phone:360-634-8949
Practice Address - Fax:360-634-8234
Is Sole Proprietor?:No
Enumeration Date:2012-06-10
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK138797363A00000X, 363A00000X
WAPA60299976363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant