Provider Demographics
NPI:1942443668
Name:CLANCY, KRISTEN ANN (RPA-C)
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:ANN
Last Name:CLANCY
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:3435 BAILEY AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-1145
Mailing Address - Country:US
Mailing Address - Phone:716-835-2966
Mailing Address - Fax:716-834-3901
Practice Address - Street 1:3435 BAILEY AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-1145
Practice Address - Country:US
Practice Address - Phone:716-835-2966
Practice Address - Fax:716-834-3901
Is Sole Proprietor?:No
Enumeration Date:2009-04-10
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY013137363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant