M L Clemson Corporation

Primary specialty

Adult Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0809X

License

0015000529 Issued in VA

Legal business name

M L CLEMSON CORPORATION

Practice address

602 Massachusetts Ave
Norfolk, VA 23508-2118

Phone

(757) 622-6673

Fax

(757) 622-1086

NPI assigned

Aug 4, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Mary Louise Clemson, PSY CNSNPI 1750563086

Title

President

Phone

(757) 622-6673

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mar Y Louise Clemson, RNCS

  • Psychiatric/Mental Health Registered Nurse
  • Norfolk, VA
  • NPI 1750563086
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1206489600000",
    "number": "1033127188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "602 MASSACHUSETTS AVE",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235082118",
            "telephone_number": "757-622-6673",
            "fax_number": "757-622-1086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 MASSACHUSETTS AVE",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235082118",
            "telephone_number": "757-622-6673",
            "fax_number": "757-622-1086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "M L CLEMSON CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-04",
        "last_updated": "2008-03-26",
        "status": "A",
        "authorized_official_last_name": "CLEMSON",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "LOUISE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "757-622-6673",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PSY CNS"
    },
    "taxonomies": [
        {
            "code": "163WP0809X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Adult",
            "state": "VA",
            "license": "0015000529",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM GROUP",
            "identifier": "101867",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "C08982",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "101868",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "P00071810",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1750563086",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dale Anthony Lyons, IDC
• Dorothy Araline Lyons, M.D.
• John Paul Lyons
• Maxine E Lyons, NP
• Jessica Dawn Lyttle, NR EMT-B
• Catherine Lyn Maccaskill-Whitethorne, MSED
• Patrick Maceachern
• Ashley Brianna Machmer
• Alexandra Sledd Mack, M.D.
• Marie Mack, MD

• Adult Psychiatric/Mental Health Registered Nurse in Norfolk, VA
• Providers in Norfolk, VA by specialty
• Adult Psychiatric/Mental Health Registered Nurse in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.