Carson Mitchell Clemons, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

9114474 Issued in FL

Practice address

4268 Oldfield Crossing Dr Ste 303
Jacksonville, FL 32223-7899

Phone

(904) 325-9386

Fax

(904) 650-2911

NPI assigned

Aug 23, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Carson Emma Mitchell 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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Florida Trauma Services, LLC

  • Trauma Surgery Physician
  • Fort Walton Beach, FL
  • NPI 1477296952
  Medicare reassignment
• Granzow Medical LLP

  • Plastic Surgery Physician
  • Jacksonville, FL
  • NPI 1912624263
  NPD
• GLL Center, LLC

  • Plastic and Reconstructive Surgery Physician
  • Kingsland, GA
  • NPI 1932899630
  NPD
• Georgia Spine & Pain Centers

  • Interventional Pain Medicine Physician
  • Waycross, GA
  • NPI 1134769714
  NPD (past)

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

{
    "created_epoch": "1629676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705968000000",
    "number": "1710654348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4268 OLDFIELD CROSSING DR STE 303",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322237899",
            "telephone_number": "904-325-9386",
            "fax_number": "904-650-2911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4268 OLDFIELD CROSSING DR STE 303",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322237899",
            "telephone_number": "904-325-9386",
            "fax_number": "904-650-2911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLEMONS",
        "first_name": "CARSON",
        "middle_name": "MITCHELL",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-23",
        "last_updated": "2024-01-23",
        "certification_date": "2024-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA63282",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "11875",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "9114474",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CARSON",
            "last_name": "MITCHELL",
            "middle_name": "EMMA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Raquel Clement, RBT
• William J Clement II, DDS
• Christopher Clements, DPT
• Jared Clements
• Noah Andrew Clements
• Kayla Ashante Clemons, APRN
• Robin Clemons
• Steven Clendenen, MD
• Jacob N Clendenon, MD
• La'Reesha Clercira

• Physician Assistant in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2024; 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.