Provider Demographics
NPI:1811907371
Name:CLEMENT, KATHRYN A (FNP-C)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:A
Last Name:CLEMENT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:KATHYRN
Other - Middle Name:
Other - Last Name:KLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:PO BOX 840026
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0026
Mailing Address - Country:US
Mailing Address - Phone:806-212-6965
Mailing Address - Fax:806-212-6278
Practice Address - Street 1:3501 S SONCY RD
Practice Address - Street 2:SUITE 150
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-6407
Practice Address - Country:US
Practice Address - Phone:806-212-6353
Practice Address - Fax:806-212-0558
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX610458363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX140451100OtherFIRST CARE
TX172829703Medicaid
TX140451100OtherSOUTHWEST LIFE & HEALTH
TX140451100OtherFIRST CARE
TX140451100OtherSOUTHWEST LIFE & HEALTH
TX132671Medicaid