Healthcare Provider Details

I. General information

NPI: 1609538883
Provider Name (Legal Business Name): ASHLEY LORI MCCLAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2021
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 HOWARD AVE
ALTOONA PA
16601-4804
US

IV. Provider business mailing address

321 HUNTERS PASS DR
DUNCANSVILLE PA
16635-8358
US

V. Phone/Fax

Practice location:
  • Phone: 814-889-2011
  • Fax:
Mailing address:
  • Phone: 814-935-4008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA062981
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: