Provider Demographics
NPI:1841397296
Name:MCCLINCY, DANIEL KENNETH (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:KENNETH
Last Name:MCCLINCY
Suffix:
Gender:M
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 1:543 TAYLOR AVE.
Mailing Address - Street 2:CHYLMERS P WYLIE VA OUTPATIENT CLINIC
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43203
Mailing Address - Country:US
Mailing Address - Phone:614-257-5377
Mailing Address - Fax:
Practice Address - Street 1:543 TAYLOR AVE.
Practice Address - Street 2:VAOPC
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43203
Practice Address - Country:US
Practice Address - Phone:614-257-5377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.002047363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant