Provider Demographics
NPI:1851470561
Name:MCCLATCHY, AMY (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:MCCLATCHY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 HICKORY ST
Mailing Address - Street 2:SUITE #102
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-2334
Mailing Address - Country:US
Mailing Address - Phone:325-677-2801
Mailing Address - Fax:
Practice Address - Street 1:1850 HICKORY ST
Practice Address - Street 2:SUITE #102
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2334
Practice Address - Country:US
Practice Address - Phone:325-677-2801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5368208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152569100OtherFIRSTCARE HMO
TX184027402Medicaid
TX8M2791OtherBLUE CROSS BLUE SHIELD
TX142911OtherSUPERIOR / CHIP
TX142911OtherSUPERIOR / CHIP
TX184027402Medicaid