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General NPI Number Information
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NPI Number | 1154961381
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Entity Type | Individual
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Provider Name | KRISTIN MARIE CLEMENS PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 01/15/2020
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Last Update Date | 05/04/2020
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Provider Practice Location Address
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Address Line | 800 S FREDERICK AVE STE 200A
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City | GAITHERSBURG
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State | MD
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Zip | 20877-4152
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Country | US
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Telephone | 877-588-0282
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Fax | 301-880-0228
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Provider Business Mailing Address
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Address Line | 5940 BARON KENT LN
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City | CENTREVILLE
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State | VA
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Zip | 20120-3438
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Country | US
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Telephone | 877-588-0282
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Fax | 301-880-0228
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AC003082
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License Number State | MD
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