Provider Demographics
NPI:1396769212
Name:CLEMONS, TERESA L (ANP)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:L
Last Name:CLEMONS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9250 AMBERTON PKWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3224
Mailing Address - Country:US
Mailing Address - Phone:682-236-3656
Mailing Address - Fax:
Practice Address - Street 1:9250 AMBERTON PKWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3224
Practice Address - Country:US
Practice Address - Phone:682-236-3656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP111228363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX161086703Medicaid
TX161086707Medicaid
TX161086704Medicaid
TX161086705Medicaid
TX161086709Medicaid
TX161086708Medicaid
TX161086702Medicaid
TXTXB123270Medicare PIN
TX8L9292Medicare PIN
TX8J4092Medicare PIN
TXP44703Medicare UPIN
TXTXB123271Medicare PIN
TX161086704Medicaid
TX161086709Medicaid
TX8L9138Medicare PIN
TX8L9139Medicare PIN