HOLLY CLEMENTS — NPI 1093224735 (Licensed & Credentialed Licensed Practical Nurse in CROSS CITY, FL)

CMS-1500 Box 24J / 33a • NPI

1093224735

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

164W00000X

Licensed & Credentialed Licensed Practical Nurse

Box 32 Service Location & ZIP+4

471 NE 214TH AVE, CROSS CITY, FL, 32628

Official NPPES Practice Location

Practice Phone & Referral Fax

(352) 210-0577

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1093224735 (HOLLY CLEMENTS) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1093224735` (NPI-1 Individual Practitioner)
Provider / Legal Name	HOLLY CLEMENTS
Plain-English Specialty	Licensed & Credentialed Licensed Practical Nurse NUCC Code: `164W00000X` (Licensed Practical Nurse)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	471 NE 214TH AVE, CROSS CITY, FL, 32628
Practice Telephone / Fax	Tel: (352) 210-0577
Administrative Mailing Address	471 NE 214TH AVE, CROSS CITY, FL, 32628-3397
Enumeration & Last Sync	Enumerated: 2017-09-26 \| CMS Record Updated: 2022-07-21

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

471 NE 214TH AVE, CROSS CITY, FL, 32628

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Plain-English Taxonomy & CMS Crosswalk (164W00000X)

What Does Taxonomy Code 164W00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 164W00000X translates to:
"Licensed & Credentialed Licensed Practical Nurse"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Licensed Practical Nurse for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (HOLLY CLEMENTS)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`164W00000X` — Licensed Practical Nurse Plain English: Licensed & Credentialed Licensed Practical Nurse	State: FL \| License: `5227277` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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HOLLY CLEMENTS (NPI #1093224735)