MEDICARE: ALARISE JACQUELYN CLAY P.A.-C, M.C.E.P.

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	363AM0700X	Medical Physician Assistant	5349-23	WI
2	363A00000X	Physician Assistant	5349-23	WI

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

General Provider Information

NPI Number	:	1770860033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALARISE JACQUELYN CLAY P.A.-C, M.C.E.P.

Provider Business Mailing Address
First Line	:	1305 PRAIRIE ROSE DR
Second Line	:
City	:	SUN PRAIRIE
State	:	WI
Zip	:	53590-4314
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1305 PRAIRIE ROSE DR
Second Line	:
City	:	SUN PRAIRIE
State	:	WI
Zip	:	53590-4314
Country	:	US
Telephone Number	:	608-828-7603
Fax Number	:

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

Provider Enumeration Date	:	11/14/2011
Last Update Date	:	06/01/2026

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