Provider Demographics
NPI:1659445666
Name:CLAYPOOLE, MANDY LYN (MPAS PA C)
Entity Type:Individual
Prefix:MS
First Name:MANDY
Middle Name:LYN
Last Name:CLAYPOOLE
Suffix:
Gender:F
Credentials:MPAS PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 E BRADY ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001
Mailing Address - Country:US
Mailing Address - Phone:724-282-1627
Mailing Address - Fax:724-282-4810
Practice Address - Street 1:901 E BRADY ST
Practice Address - Street 2:SUITE 103
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001
Practice Address - Country:US
Practice Address - Phone:724-282-1627
Practice Address - Fax:724-282-4810
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051153363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant