Provider Demographics
NPI:1093344186
Name:MCCLUNG, HAYLIE RAY (PA-C)
Entity Type:Individual
Prefix:
First Name:HAYLIE
Middle Name:RAY
Last Name:MCCLUNG
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 1:620 229TH LN NE
Mailing Address - Street 2:
Mailing Address - City:EAST BETHEL
Mailing Address - State:MN
Mailing Address - Zip Code:55005-9801
Mailing Address - Country:US
Mailing Address - Phone:763-370-8033
Mailing Address - Fax:
Practice Address - Street 1:1875 DEMPSTER ST STE 665
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1168
Practice Address - Country:US
Practice Address - Phone:847-825-1590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-02
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program