Provider Demographics
NPI:1184478091
Name:CLEMONS, TAKEELA CHOUNTA
Entity type:Individual
Prefix:
First Name:TAKEELA
Middle Name:CHOUNTA
Last Name:CLEMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 S FLORISSANT RD
Mailing Address - Street 2:
Mailing Address - City:FERGUSON
Mailing Address - State:MO
Mailing Address - Zip Code:63135-2733
Mailing Address - Country:US
Mailing Address - Phone:314-456-7519
Mailing Address - Fax:
Practice Address - Street 1:103 S FLORISSANT RD
Practice Address - Street 2:
Practice Address - City:FERGUSON
Practice Address - State:MO
Practice Address - Zip Code:63135-2733
Practice Address - Country:US
Practice Address - Phone:314-456-7519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health