Healthcare Provider Details

I. General information

NPI: 1134057219
Provider Name (Legal Business Name): ASHLEY CLEM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3843 GEORGETOWN RD
HORNER WV
26372-9626
US

IV. Provider business mailing address

3843 GEORGETOWN RD
HORNER WV
26372-9626
US

V. Phone/Fax

Practice location:
  • Phone: 304-476-6816
  • Fax: 304-476-6816
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number122911
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: