Healthcare Provider Details

I. General information

NPI: 1922525237
Provider Name (Legal Business Name): SCOTT A. CLEMENT APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2017
Last Update Date: 08/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 BALD HILL RD STE 511
WARWICK RI
02886-6100
US

IV. Provider business mailing address

2 PROSPECT ST
EAST GREENWICH RI
02818-3217
US

V. Phone/Fax

Practice location:
  • Phone: 401-738-8100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN01669
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: