| Organization Name: | JAN CLEMENTS AGNP CORP |
| NPI Number: | 1124434501 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JAN CLEMENTS (NURSE PRACTIONER) |
| Mailing Address: | 66 E State Rd Pleasant Grove |
| State: | UT US |
| Postal Code: | 840622637 |
| Phone Number: | 8017967961 |
| Fax Number: | 8017961101 |
| NPI Enumeration Date: | 07/07/2014 |
| NPI Last Update Date: | 07/07/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 1938944405 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | UT |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |