Provider Demographics
NPI:1396245684
Name:CLEMENTSON, JODIE M (DO)
Entity type:Individual
Prefix:
First Name:JODIE
Middle Name:M
Last Name:CLEMENTSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:9500 KANIS RD STE 501
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6389
Mailing Address - Country:US
Mailing Address - Phone:501-227-9080
Mailing Address - Fax:501-227-0490
Practice Address - Street 1:9500 KANIS RD STE 501
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6389
Practice Address - Country:US
Practice Address - Phone:501-227-9080
Practice Address - Fax:501-227-0490
Is Sole Proprietor?:No
Enumeration Date:2018-02-14
Last Update Date:2024-09-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARE-16285208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery