Healthcare Provider Details

I. General information

NPI: 1881281723
Provider Name (Legal Business Name): KYLIE ALLISSA MCCLAIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KYLIE ALISSA HANNOLD

II. Dates (important events)

Enumeration Date: 12/27/2020
Last Update Date: 02/21/2023
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 HOSPITAL AVE
DU BOIS PA
15801-1409
US

IV. Provider business mailing address

100 HOSPITAL AVE
DU BOIS PA
15801-1440
US

V. Phone/Fax

Practice location:
  • Phone: 814-371-1900
  • Fax: 814-503-8568
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA062018
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: