Individual
NICOLE WHITMAN CLEMENTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
301 UNSER BLVD NW, ALBUQUERQUE, NM 87121
(505) 925-4126
(505) 925-4721
Mailing address
933 BRADBURY DR SE STE 2222, ALBUQUERQUE, NM 87106-4375
(505) 272-3120
(505) 272-8060
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2019-0003
NM
363A00000X
Physician Assistant
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
TEMPORARY
TEXAS PHYSICIAN ASSISTANT BOARD
TX
Enumeration date
10/24/2017
Last updated
02/13/2019
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