1932441987 NPI number — JENNIFER HARSHAW CLEMENTS CFNP

Table of content: JENNIFER HARSHAW CLEMENTS CFNP (NPI 1932441987)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932441987 NPI number — JENNIFER HARSHAW CLEMENTS CFNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLEMENTS
Provider First Name:
JENNIFER
Provider Middle Name:
HARSHAW
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CFNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932441987
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/20/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
129 N BROOKMOORE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39705-2024
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-988-2014
Provider Business Mailing Address Fax Number:
615-864-7565

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7474 HIGHWAY 45 ALT N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST POINT
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39773-7981
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-494-5863
Provider Business Practice Location Address Fax Number:
662-494-5287
Provider Enumeration Date:
03/17/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  R867470 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: F0113156 . This is a "AMERICAN ACADEMY OF NURSE PRACTITIONERS CERTIFICATION PROGRAM" identifier . This identifiers is of the category "OTHER".