Provider Demographics
NPI:1104459833
Name:CLEMOENS, ZAKIYA S (NP)
Entity type:Individual
Prefix:
First Name:ZAKIYA
Middle Name:S
Last Name:CLEMOENS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 W 101ST TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-4236
Mailing Address - Country:US
Mailing Address - Phone:816-914-4065
Mailing Address - Fax:
Practice Address - Street 1:629 W 101ST TER
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4236
Practice Address - Country:US
Practice Address - Phone:816-914-4065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-21
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020007316363LA2100X
KS5379289071363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care