Provider Demographics
NPI:1942822499
Name:KLECKNER, AYANA ASHAY
Entity Type:Individual
Prefix:
First Name:AYANA
Middle Name:ASHAY
Last Name:KLECKNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 W NATIONAL RD
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:OH
Mailing Address - Zip Code:45377-1969
Mailing Address - Country:US
Mailing Address - Phone:937-898-3600
Mailing Address - Fax:937-898-2731
Practice Address - Street 1:235 W NATIONAL RD
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45377-1969
Practice Address - Country:US
Practice Address - Phone:937-898-3600
Practice Address - Fax:937-898-2731
Is Sole Proprietor?:No
Enumeration Date:2020-05-07
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.025254363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily