Provider Demographics
NPI:1902301963
Name:CLEMMONS, RUTH SUZANNE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:SUZANNE
Last Name:CLEMMONS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:RUTH
Other - Middle Name:SUZANNE
Other - Last Name:MCCOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 S UNIVERSITY AVE STE 615
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5308
Mailing Address - Country:US
Mailing Address - Phone:501-666-3666
Mailing Address - Fax:501-907-9069
Practice Address - Street 1:500 S UNIVERSITY AVE STE 615
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5308
Practice Address - Country:US
Practice Address - Phone:501-666-3666
Practice Address - Fax:501-907-9069
Is Sole Proprietor?:No
Enumeration Date:2018-03-29
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPA-776363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARPA-776OtherLICENSE