MEDICARE: MRS. SAMANTHA MARY-KATHLEEN CLEMONS FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	1032185	TX

General Provider Information

NPI Number	:	1164007563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SAMANTHA MARY-KATHLEEN CLEMONS FNP-C

Provider Business Mailing Address
First Line	:	2510 S LOOP 336 W STE 115
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77304-3737
Country	:	US
Telephone Number	:	936-235-2825
Fax Number	:	936-235-2826

Provider Business Practice Location Address
First Line	:	2510 S LOOP 336 W STE 115
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77304-3737
Country	:	US
Telephone Number	:	369-235-2825
Fax Number	:	936-235-2826

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2021
Last Update Date	:	09/09/2021

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