Provider Demographics
NPI:1386125177
Name:CLAYCOMB, CARRIE (PA-C)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:CLAYCOMB
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:ORBISONIA
Mailing Address - State:PA
Mailing Address - Zip Code:17243-0040
Mailing Address - Country:US
Mailing Address - Phone:814-447-5556
Mailing Address - Fax:814-447-5682
Practice Address - Street 1:626 WATER ST STE 1
Practice Address - Street 2:
Practice Address - City:ORBISONIA
Practice Address - State:PA
Practice Address - Zip Code:17243-9432
Practice Address - Country:US
Practice Address - Phone:814-447-5556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant