MEDICARE: ANDREA D. CLEMENT PA

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	363A00000X	Physician Assistant	627	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	35441	OTHER	NE	BCBS

General Provider Information

NPI Number	:	1427033653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA D. CLEMENT PA

Provider Business Mailing Address
First Line	:	2115 N KANSAS AVE STE 103
Second Line	:
City	:	HASTINGS
State	:	NE
Zip	:	68901-2615
Country	:	US
Telephone Number	:	402-463-6828
Fax Number	:	402-463-4767

Provider Business Practice Location Address
First Line	:	2115 N KANSAS AVE STE 103
Second Line	:
City	:	HASTINGS
State	:	NE
Zip	:	68901-2615
Country	:	US
Telephone Number	:	402-463-6828
Fax Number	:	402-463-4767

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

Provider Enumeration Date	:	12/09/2005
Last Update Date	:	03/17/2018

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