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NPI Code Detail

MEDICARE: LESIA NICOLE CLUTE APRN, FNP-C

MEDICARE: LESIA NICOLE CLUTE APRN, FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner122345AR

General Provider Information

NPI Number : 1124662093
Entity Type Code : Individual
Provider Name (Legal Business Name) : LESIA NICOLE CLUTE APRN, FNP-C
Provider Business Mailing Address
First Line : 145 SHAKE RAG RD
Second Line :
City : CLINTON
State : AR
Zip : 72031-6682
Country : US
Telephone Number : 501-253-6208
Fax Number :
Provider Business Practice Location Address
First Line : 145 SHAKE RAG RD
Second Line :
City : CLINTON
State : AR
Zip : 72031-6682
Country : US
Telephone Number : 501-253-6208
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/04/2019
Last Update Date : 11/04/2019

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