Provider Demographics
NPI:1255129367
Name:STILL WATERS CLINIC,PLLC
Entity type:Organization
Organization Name:STILL WATERS CLINIC,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CLERISSON
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:267-886-2634
Mailing Address - Street 1:261 OLD YORK RD STE 611
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-3718
Mailing Address - Country:US
Mailing Address - Phone:267-886-2634
Mailing Address - Fax:
Practice Address - Street 1:261 OLD YORK RD STE 611
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-3718
Practice Address - Country:US
Practice Address - Phone:267-886-2634
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty