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Individual
MRS. KIM SPROUSE CLEMENTS
Active
Individual
MRS. KIM SPROUSE CLEMENTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN, CNP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R0030796
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30796
STATE LICENSE
OK
Enumeration date
09/15/2005
Last updated
07/01/2014
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