Healthcare Provider Details

I. General information

NPI: 1851470561
Provider Name (Legal Business Name): AMY MCCLATCHY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 08/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 HICKORY ST SUITE #102
ABILENE TX
79601-2334
US

IV. Provider business mailing address

1850 HICKORY ST SUITE #102
ABILENE TX
79601-2334
US

V. Phone/Fax

Practice location:
  • Phone: 325-677-2801
  • Fax:
Mailing address:
  • Phone: 325-677-2801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberM5368
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: