Provider Demographics
NPI:1053769380
Name:CLEMENTS, ERIN
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2751 ALBERT L BICKNELL DR STE 2D
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-3939
Mailing Address - Country:US
Mailing Address - Phone:318-212-4232
Mailing Address - Fax:318-212-4257
Practice Address - Street 1:2751 ALBERT L BICKNELL DR STE 2D
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-3939
Practice Address - Country:US
Practice Address - Phone:318-212-4232
Practice Address - Fax:318-212-4257
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-26
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA312201207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2419081Medicaid