Provider Demographics
NPI:1396117081
Name:CLEMONS, KIMBERLY (FNP-BC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:CLEMONS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 BRAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-0856
Mailing Address - Country:US
Mailing Address - Phone:912-480-9444
Mailing Address - Fax:912-228-4654
Practice Address - Street 1:1555 BRAMPTON AVE
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-0856
Practice Address - Country:US
Practice Address - Phone:912-480-9444
Practice Address - Fax:912-228-4654
Is Sole Proprietor?:No
Enumeration Date:2015-10-21
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN207330364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health