Provider Demographics
NPI:1104287507
Name:KLEMENT, DONNA JUNE (NP-C)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:JUNE
Last Name:KLEMENT
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 637
Mailing Address - Street 2:2611 CROSSROADS DR
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73402-0637
Mailing Address - Country:US
Mailing Address - Phone:580-223-8614
Mailing Address - Fax:580-223-2561
Practice Address - Street 1:125 DAVIS BLVD
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-8209
Practice Address - Country:US
Practice Address - Phone:682-212-9104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-11
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF0116338207RN0300X
TXAP130152363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX362889302Medicaid