Healthcare Provider Details

I. General information

NPI: 1285963207
Provider Name (Legal Business Name): ABBY CLEMENS MMS, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2009
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 N MILFORD DR
FRANKLIN IN
46131-7308
US

IV. Provider business mailing address

55 N MILFORD DR
FRANKLIN IN
46131-7308
US

V. Phone/Fax

Practice location:
  • Phone: 317-739-4848
  • Fax: 317-878-2355
Mailing address:
  • Phone: 317-648-7169
  • Fax: 317-878-2355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10001587A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: