Healthcare Provider Details

I. General information

NPI: 1528369360
Provider Name (Legal Business Name): ADRIENNE RENEE MCCLEARY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2010
Last Update Date: 01/04/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 SUNCREST TOWN CENTRE DR SUITE 310
MORGANTOWN WV
26505-0589
US

IV. Provider business mailing address

4001 W 15TH ST STE 425
PLANO TX
75093-5848
US

V. Phone/Fax

Practice location:
  • Phone: 304-598-2200
  • Fax: 304-599-2674
Mailing address:
  • Phone: 972-696-0030
  • Fax: 972-696-0037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA054550
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: