Provider Demographics
NPI:1740511005
Name:ANDERSON, CLINTON M (MT, PA-C)
Entity type:Individual
Prefix:
First Name:CLINTON
Middle Name:M
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MT, PA-C
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Other - Credentials:
Mailing Address - Street 1:PO BOX 778413
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89077-8413
Mailing Address - Country:US
Mailing Address - Phone:702-357-8811
Mailing Address - Fax:
Practice Address - Street 1:2900 W HORIZON RIDGE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5014
Practice Address - Country:US
Practice Address - Phone:702-357-8811
Practice Address - Fax:702-947-5352
Is Sole Proprietor?:No
Enumeration Date:2010-01-26
Last Update Date:2021-03-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NV260790928363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical