Provider Demographics
NPI:1881339836
Name:CLEMMONS, JACQUELYN KATHLEEN
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:KATHLEEN
Last Name:CLEMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6724 GLENKIRK RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-1410
Mailing Address - Country:US
Mailing Address - Phone:443-882-1626
Mailing Address - Fax:
Practice Address - Street 1:6724 GLENKIRK RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-1410
Practice Address - Country:US
Practice Address - Phone:443-882-1626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty