Healthcare Provider Details

I. General information

NPI: 1508600354
Provider Name (Legal Business Name): JOHN CLEMENTS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2024
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 10TH AVE N
BILLINGS MT
59101-0703
US

IV. Provider business mailing address

14695 MEADOW BEND DR
FISHERS IN
46037-4230
US

V. Phone/Fax

Practice location:
  • Phone: 406-238-2500
  • Fax:
Mailing address:
  • Phone: 308-216-1893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNUR-APRN-LIC-240075
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberNUR-APRN-LIC-240075
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: