Provider Demographics
NPI:1841830601
Name:MCINTYRE, DAVID CLAY (AGNP-C)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:CLAY
Last Name:MCINTYRE
Suffix:
Gender:M
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 FM 241 S
Mailing Address - Street 2:
Mailing Address - City:RUSK
Mailing Address - State:TX
Mailing Address - Zip Code:75785-5319
Mailing Address - Country:US
Mailing Address - Phone:903-721-3622
Mailing Address - Fax:
Practice Address - Street 1:7924 S BROADWAY AVE STE 900
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-5252
Practice Address - Country:US
Practice Address - Phone:903-352-3161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141680363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner