Provider Demographics
NPI:1841547239
Name:CLYDE, ABBE MICHELE (PA-C)
Entity type:Individual
Prefix:MISS
First Name:ABBE
Middle Name:MICHELE
Last Name:CLYDE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ABBE
Other - Middle Name:MICHELE
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:606 COMMUNITY WAY
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-2329
Mailing Address - Country:US
Mailing Address - Phone:610-687-8771
Mailing Address - Fax:
Practice Address - Street 1:606 COMMUNITY WAY
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-2329
Practice Address - Country:US
Practice Address - Phone:610-687-8771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018655363A00000X
DEC5-0000831363A00000X
PAMA061783363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000024689Medicaid
DE1000024689Medicaid