Provider Demographics
NPI:1609087196
Name:CLANCY, ALLISON PAIGE (RN, FNP, CPNP-AC)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:PAIGE
Last Name:CLANCY
Suffix:
Gender:F
Credentials:RN, FNP, CPNP-AC
Other - Prefix:MISS
Other - First Name:ALLISON
Other - Middle Name:PAIGE
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, FNP
Mailing Address - Street 1:3128 WILD PLUM DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-2061
Mailing Address - Country:US
Mailing Address - Phone:817-927-6513
Mailing Address - Fax:
Practice Address - Street 1:1935 MOTOR ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7701
Practice Address - Country:US
Practice Address - Phone:214-456-7881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX606087363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics