Healthcare Provider Details

I. General information

NPI: 1588223861
Provider Name (Legal Business Name): HERMIEN CLYBURN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4358 LOCKHILL SELMA RD
SAN ANTONIO TX
78249-4161
US

IV. Provider business mailing address

4358 LOCKHILL SELMA RD STE 110
SAN ANTONIO TX
78249-4167
US

V. Phone/Fax

Practice location:
  • Phone: 210-492-4300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number120142
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: