Provider Demographics
NPI:1962280842
Name:CLEMMER, NICHOLE (CNHP)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:CLEMMER
Suffix:
Gender:F
Credentials:CNHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1573 FORT CAMPBELL BLVD # 1573
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-3535
Mailing Address - Country:US
Mailing Address - Phone:937-545-3936
Mailing Address - Fax:
Practice Address - Street 1:1573 FORT CAMPBELL BLVD # 1573
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-3535
Practice Address - Country:US
Practice Address - Phone:937-545-3936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program