MEDICARE: MRS. HOLLY CELESTE CLEMENTS ARNP

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
1	363LF0000X	Family Nurse Practitioner	AP60405648	WA

General Provider Information

NPI Number	:	1366876120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HOLLY CELESTE CLEMENTS ARNP

Provider Business Mailing Address
First Line	:	PO BOX 3360
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97208-3360
Country	:	US
Telephone Number	:	866-747-2455
Fax Number	:

Provider Business Practice Location Address
First Line	:	954 ANDERSON DR STE 102
Second Line	:	PMG SW WA PRCS ABERDEEN CLINIC
City	:	ABERDEEN
State	:	WA
Zip	:	98520-1001
Country	:	US
Telephone Number	:	360-533-6906
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2013
Last Update Date	:	05/03/2021

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