Basic Information
| Provider Information | |||||||||
| NPI: | 1831288752 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCCLUNG | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 OLD WINSTON RD | ||||||||
| Address2: | SUITE 222 | ||||||||
| City: | KERNERSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272848119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3369921234 | ||||||||
| FaxNumber: | 3369939963 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 OLD WINSTON RD | ||||||||
| Address2: | STE 222 | ||||||||
| City: | KERNERSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272848119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3369921234 | ||||||||
| FaxNumber: | 3369939963 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2006 | ||||||||
| LastUpdateDate: | 03/19/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 102620 | NC | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 102620 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.