Provider Demographics
NPI:1831288752
Name:MCCLUNG, ANGELA M (PA-C)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:MCCLUNG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 OLD WINSTON RD
Mailing Address - Street 2:SUITE 222
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-8119
Mailing Address - Country:US
Mailing Address - Phone:336-992-1234
Mailing Address - Fax:336-993-9963
Practice Address - Street 1:900 OLD WINSTON RD
Practice Address - Street 2:STE 222
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-8119
Practice Address - Country:US
Practice Address - Phone:336-992-1234
Practice Address - Fax:336-993-9963
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102620363A00000X
GA102620363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCQ75359Medicare UPIN
Q75359Medicare UPIN