Individual
CARRIE A CLEMENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
100 SENTARA CIR, WILLIAMSBURG, VA 23188-5713
(757) 984-6000
Mailing address
111 BULIFANTS BLVD STE B, T-SYSTEM WILLIAMSBURG, WILLIAMSBURG, VA 23188-5711
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0110002304
VA
363AS0400X
Surgical Physician Assistant
Primary
0110002304
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1164469896
—
VA
01
—
11765311
CAQH
VA
Enumeration date
06/01/2006
Last updated
06/23/2014
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