Provider Demographics
NPI:1518957869
Name:CLEARY, BARRY J (PA-C)
Entity Type:Individual
Prefix:MR
First Name:BARRY
Middle Name:J
Last Name:CLEARY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:BARRY
Other - Middle Name:
Other - Last Name:CLEARY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1944 JACKSONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BAGDAD
Mailing Address - State:KY
Mailing Address - Zip Code:40003-6008
Mailing Address - Country:US
Mailing Address - Phone:502-747-0706
Mailing Address - Fax:
Practice Address - Street 1:615 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-1131
Practice Address - Country:US
Practice Address - Phone:502-647-4668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical