Roselyn Jan Wuthrich Clemente Fuentes, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

ME118266 Issued in FL

Practice address

24TH Sow/STTS Annex Building
301 Tully St
Hurlburt Field, FL 32544

Phone

(850) 884-3902

NPI assigned

May 13, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Roselyn Jan Wuthrich Clemente Former name

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1273708800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687219200000",
    "number": "1699093781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24TH SOW/STTS ANNEX BUILDING",
            "address_2": "301 TULLY ST",
            "city": "HURLBURT FIELD",
            "state": "FL",
            "postal_code": "32544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24TH SOW/STTS ANNEX BUILDING",
            "address_2": "301 TULLY ST",
            "city": "HURLBURT FIELD",
            "state": "FL",
            "postal_code": "32544",
            "telephone_number": "850-884-3902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLEMENTE FUENTES",
        "first_name": "ROSELYN JAN",
        "middle_name": "WUTHRICH",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-05-13",
        "last_updated": "2023-06-20",
        "certification_date": "2023-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NE",
            "license": "26386",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME118266",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ROSELYN JAN",
            "last_name": "CLEMENTE",
            "middle_name": "WUTHRICH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Donald Harold Chattin, DDS
• Whay-Yih Cheng, DO
• Eric M Chumbley, MD
• Teresa Clark, LCSW, QS
• Brian Michael Clement, DDS
• Alexandra Nicole Cleveland
• Tyrus Colbert
• Nigel Contaste, IDMT
• Cope and Wit Counseling
• Allison M Cope, CADC

• Family Medicine Physician in Hurlburt Field, FL
• Providers in Hurlburt Field, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.