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Individual

JASON CLEMONS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
304 S 29TH ST, CHICKASHA, OK 73018-2501
(058) 968-0584
(855) 223-1999
Mailing address
PO BOX 929, CHICKASHA, OK 73023-0929
(405) 896-8058
(855) 223-1999

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
73444
OK
363LF0000X
Family Nurse Practitioner
Primary
73444
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1548678139
NPI
OK
Enumeration date
07/26/2014
Last updated
12/18/2019
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