Provider Demographics
NPI:1205181013
Name:MCCLARY, ASHLEY DIOR
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:DIOR
Last Name:MCCLARY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6804 N CAPITAL OF TEXAS HWY
Mailing Address - Street 2:APT 723
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-1771
Mailing Address - Country:US
Mailing Address - Phone:843-356-0975
Mailing Address - Fax:
Practice Address - Street 1:3607 MANOR RD
Practice Address - Street 2:STE 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-5816
Practice Address - Country:US
Practice Address - Phone:512-928-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY363A00000X
TXPA10174363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant