Provider Demographics
NPI:1669638623
Name:MCCLAY, KRISTIN MARIE (DO)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MARIE
Last Name:MCCLAY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:MARIE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:KIDRON
Mailing Address - State:OH
Mailing Address - Zip Code:44636-0247
Mailing Address - Country:US
Mailing Address - Phone:330-857-0177
Mailing Address - Fax:330-857-0190
Practice Address - Street 1:12991 EMERSON RD
Practice Address - Street 2:
Practice Address - City:APPLE CREEK
Practice Address - State:OH
Practice Address - Zip Code:44606-9302
Practice Address - Country:US
Practice Address - Phone:330-857-0177
Practice Address - Fax:330-857-0190
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.010303207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine