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General NPI Number Information
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NPI Number | 1194807651
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Entity Type | Individual
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Provider Name | MELISSA L CLARY PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 03/23/2012
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Provider Practice Location Address
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Address Line | 1709 EAST BLVD
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City | CHARLOTTE
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State | NC
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Zip | 28203-5823
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Country | US
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Telephone | 704-333-6642
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Fax | 704-332-6642
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Provider Business Mailing Address
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Address Line | 100 HAWTHORN LN
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City | DANIELS
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State | WV
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Zip | 25832-9269
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Country | US
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Telephone | 304-763-8555
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 01237
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 0010-03356
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License Number State | NC
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