Healthcare Provider Details

I. General information

NPI: 1942608328
Provider Name (Legal Business Name): JINNYI CLEMENTS AGCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2014
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 KIMSEY LN
HENDERSON KY
42420-2665
US

IV. Provider business mailing address

36 PEMBERTON CV
JACKSON TN
38305-5514
US

V. Phone/Fax

Practice location:
  • Phone: 731-394-1145
  • Fax:
Mailing address:
  • Phone: 731-394-1145
  • Fax: 844-374-0233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number71013259A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number3009770
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number3009770
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: