Provider Demographics
NPI:1922231307
Name:KIIHNL, CLAYTON MICHAEL (PA-C)
Entity Type:Individual
Prefix:
First Name:CLAYTON
Middle Name:MICHAEL
Last Name:KIIHNL
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 1:501 VIRGINIA DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-7331
Mailing Address - Country:US
Mailing Address - Phone:870-793-2371
Mailing Address - Fax:870-793-7585
Practice Address - Street 1:501 VIRGINIA DR
Practice Address - Street 2:SUITE C
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7331
Practice Address - Country:US
Practice Address - Phone:870-793-2371
Practice Address - Fax:870-793-7585
Is Sole Proprietor?:No
Enumeration Date:2009-09-01
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPA382363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARPA382OtherLICENSE
ARP00889919OtherPALMETTO GBA RAILROAD