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General NPI Number Information
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NPI Number | 1750975165
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Entity Type | Individual
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Provider Name | JOHN CLINGAN
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Gender | Male
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Dates
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Enumeration Date | 02/25/2021
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Last Update Date | 11/29/2022
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Provider Practice Location Address
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Address Line | 15004 AVERY RANCH BLVD STE 105
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City | AUSTIN
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State | TX
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Zip | 78717-4600
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Country | US
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Telephone | 512-528-7420
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Fax | 512-528-7421
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Provider Business Mailing Address
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Address Line | 611 BRAZOS BEND DR
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City | CEDAR PARK
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State | TX
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Zip | 78613-7503
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Country | US
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Telephone | 512-739-7803
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP144152
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License Number State | TX
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