Provider Demographics
NPI:1528503422
Name:MCCLAY, AMANDA NICOLE (CNM, WHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:NICOLE
Last Name:MCCLAY
Suffix:
Gender:F
Credentials:CNM, WHNP-BC
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:NICOLE
Other - Last Name:WILLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM, WHNP-BC
Mailing Address - Street 1:8110 MAPLE LAWN BLVD STE 235
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-2694
Mailing Address - Country:US
Mailing Address - Phone:301-340-8339
Mailing Address - Fax:301-340-9027
Practice Address - Street 1:3998 FAIR RIDGE DR STE 290
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-2907
Practice Address - Country:US
Practice Address - Phone:703-359-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-31
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174339363LW0102X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0024174339OtherSTATE LICENSE