Provider Demographics
NPI:1750975165
Name:CLINGAN, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:CLINGAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 BRAZOS BEND DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7503
Mailing Address - Country:US
Mailing Address - Phone:512-739-7803
Mailing Address - Fax:
Practice Address - Street 1:15004 AVERY RANCH BLVD STE 105
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78717-4600
Practice Address - Country:US
Practice Address - Phone:512-528-7420
Practice Address - Fax:512-528-7421
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-25
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP144152363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP144152OtherTX LICENSE