MEDICARE: ALISHA MARIE CLEMONS APRN

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	3011051	KY
2	363L00000X	Nurse Practitioner	3011051	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	K215870	OTHER	KY	MEDICARE MMS LOC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	3011051	OTHER	KY	MEDICAL LICENSE

General Provider Information

NPI Number	:	1205375474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISHA MARIE CLEMONS APRN

Provider Business Mailing Address
First Line	:	670 PERIMETER DR
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40517-4120
Country	:	US
Telephone Number	:	859-300-6006
Fax Number	:

Provider Business Practice Location Address
First Line	:	670 PERIMETER DR
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40517-4120
Country	:	US
Telephone Number	:	859-300-6006
Fax Number	:

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

Provider Enumeration Date	:	02/21/2017
Last Update Date	:	09/24/2025

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