Healthcare Provider Details

I. General information

NPI: 1003998964
Provider Name (Legal Business Name): KAREN ALICE CLEMENCY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 12/15/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 DENNISON AVE SUITE 200
COLUMBUS OH
43201-3497
US

IV. Provider business mailing address

1608 LAFAYETTE DR
COLUMBUS OH
43220-3867
US

V. Phone/Fax

Practice location:
  • Phone: 614-564-9067
  • Fax: 614-564-9167
Mailing address:
  • Phone: 614-208-0361
  • Fax: 614-564-9167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35053771
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03328855
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: