Provider Demographics
NPI:1427426360
Name:CLEMENTS, JAMES M (APRN)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:M
Last Name:CLEMENTS
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:MIKE
Other - Middle Name:
Other - Last Name:CLEMENTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:715 SOUTHWIND DR
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66441-9021
Mailing Address - Country:US
Mailing Address - Phone:785-209-3779
Mailing Address - Fax:785-209-3780
Practice Address - Street 1:705 1ST AVE STE A
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-4437
Practice Address - Country:US
Practice Address - Phone:620-471-3140
Practice Address - Fax:620-471-3141
Is Sole Proprietor?:No
Enumeration Date:2015-09-09
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-77022-012363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS30004457210001Medicaid
KS201127520AMedicaid