Healthcare Provider Details

I. General information

NPI: 1427962430
Provider Name (Legal Business Name): JANIE TENNEILLE CLEMONS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 PASEO DEL PUEBLO SUR
TAOS NM
87571-5972
US

IV. Provider business mailing address

1333 PASEO DEL PUEBLO SUR
TAOS NM
87571-5972
US

V. Phone/Fax

Practice location:
  • Phone: 469-222-5233
  • Fax:
Mailing address:
  • Phone: 469-222-5233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: