Healthcare Provider Details

I. General information

NPI: 1962562801
Provider Name (Legal Business Name): JENNIFER C CLEMENTE-METZ PA-C, M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 11/08/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 E 10TH ST
JEFFERSONVILLE IN
47130-6016
US

IV. Provider business mailing address

2100 MARKET ST STE 101
CHARLESTOWN IN
47111-9535
US

V. Phone/Fax

Practice location:
  • Phone: 812-288-2488
  • Fax: 770-573-9513
Mailing address:
  • Phone: 812-503-5100
  • Fax: 770-573-9513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA745
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10000891AB
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number10000891A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: