MEDICARE: ASHLEY NICHOLE MCCLENDON PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	2502	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	423828	OTHER	SC	MEDICARE RURAL
5	428926	OTHER	SC	MEDICARE RURAL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528427408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY NICHOLE MCCLENDON PA-C

Provider Business Mailing Address
First Line	:	1847 S LAKE DR
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29073-7759
Country	:	US
Telephone Number	:	803-356-8998
Fax Number	:	803-356-8999

Provider Business Practice Location Address
First Line	:	1847 S LAKE DR
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29073-7759
Country	:	US
Telephone Number	:	803-356-8998
Fax Number	:	803-356-8999

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2016
Last Update Date	:	10/22/2018

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Directions to “ ASHLEY NICHOLE MCCLENDON PA-C” Practice Location

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