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General NPI Number Information
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NPI Number | 1396245684
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Entity Type | Individual
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Provider Name | JODIE M CLEMENTSON DO
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Gender | Female
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Dates
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Enumeration Date | 02/14/2018
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Last Update Date | 09/16/2024
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Provider Practice Location Address
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Address Line | 9500 KANIS RD STE 501
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City | LITTLE ROCK
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State | AR
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Zip | 72205-6389
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Country | US
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Telephone | 501-227-9080
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Fax | 501-227-0490
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Provider Business Mailing Address
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Address Line | 9500 KANIS RD STE 501
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City | LITTLE ROCK
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State | AR
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Zip | 72205-6389
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Country | US
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Telephone | 501-227-9080
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Fax | 501-227-0490
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | E-16285
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License Number State | AR
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