Provider Demographics
NPI:1992402234
Name:CLANCY, ALLYSON NICOLE (PA)
Entity type:Individual
Prefix:MISS
First Name:ALLYSON
Middle Name:NICOLE
Last Name:CLANCY
Suffix:
Gender:F
Credentials:PA
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Other - Credentials:
Mailing Address - Street 1:1506 STERLING HILL CT
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-7607
Mailing Address - Country:US
Mailing Address - Phone:720-984-5657
Mailing Address - Fax:
Practice Address - Street 1:10012 KENNERLY RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2042
Practice Address - Country:US
Practice Address - Phone:314-525-1224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical