Healthcare Provider Details

I. General information

NPI: 1952954331
Provider Name (Legal Business Name): KATIE MICHAEL CLEMENTS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2019
Last Update Date: 09/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 RITCHIE HWY
ARNOLD MD
21012-2742
US

IV. Provider business mailing address

7580 BUCKINGHAM BLVD STE 220
HANOVER MD
21076-3210
US

V. Phone/Fax

Practice location:
  • Phone: 410-757-7600
  • Fax:
Mailing address:
  • Phone: 410-729-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR217355
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: