Provider Demographics
NPI:1780992263
Name:MCLIN, ANDREA LYNN (PA-C)
Entity type:Individual
Prefix:MISS
First Name:ANDREA
Middle Name:LYNN
Last Name:MCLIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1208
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-0021
Mailing Address - Country:US
Mailing Address - Phone:316-640-6334
Mailing Address - Fax:
Practice Address - Street 1:204 WJ BOAZ RD STE 200
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:TX
Practice Address - Zip Code:76179-4396
Practice Address - Country:US
Practice Address - Phone:817-529-1400
Practice Address - Fax:972-712-7171
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-01417363AM0700X
MO2011026869363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical