Healthcare Provider Details

I. General information

NPI: 1437440039
Provider Name (Legal Business Name): POLLY ANNA KLEMENT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2011
Last Update Date: 05/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N GRAND AVE
GAINESVILLE TX
76240-3573
US

IV. Provider business mailing address

PO BOX 647
MUENSTER TX
76252-0647
US

V. Phone/Fax

Practice location:
  • Phone: 940-612-8560
  • Fax: 940-665-0209
Mailing address:
  • Phone: 940-759-2502
  • Fax: 940-759-3608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number716516
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: