Provider Demographics
NPI:1932313996
Name:CLOCK, ALLISON RAE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:RAE
Last Name:CLOCK
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:940 N MARR RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-2610
Mailing Address - Country:US
Mailing Address - Phone:812-376-9353
Mailing Address - Fax:812-376-3757
Practice Address - Street 1:940 N MARR RD
Practice Address - Street 2:SUITE C
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-2610
Practice Address - Country:US
Practice Address - Phone:812-376-9353
Practice Address - Fax:812-376-3757
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2010-01-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN99027733A363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN4207900005Medicare NSC
IN179050MMedicare PIN
IN186780Medicare PIN