Provider Demographics
NPI:1639935497
Name:MCCLURE, BRAELYN JOY (PA-C)
Entity type:Individual
Prefix:MISS
First Name:BRAELYN
Middle Name:JOY
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8531 BENSON RD
Mailing Address - Street 2:
Mailing Address - City:LYNDEN
Mailing Address - State:WA
Mailing Address - Zip Code:98264-9711
Mailing Address - Country:US
Mailing Address - Phone:360-223-2243
Mailing Address - Fax:
Practice Address - Street 1:3015 SQUALICUM PKWY STE 200
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1906
Practice Address - Country:US
Practice Address - Phone:360-733-2092
Practice Address - Fax:360-788-6042
Is Sole Proprietor?:No
Enumeration Date:2024-02-27
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAPA61600658363AS0400X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant