Provider Demographics
NPI:1932357217
Name:MCCLUNG, HILLARY LEA (PA-C)
Entity Type:Individual
Prefix:
First Name:HILLARY
Middle Name:LEA
Last Name:MCCLUNG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:HILLARY
Other - Middle Name:LEA
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:3333 BURNET AVENUE
Mailing Address - Street 2:ML 2016
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-636-4726
Mailing Address - Fax:513-636-2808
Practice Address - Street 1:3333 BURNET AVENUE
Practice Address - Street 2:ML 2016
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3026
Practice Address - Country:US
Practice Address - Phone:513-636-4726
Practice Address - Fax:513-636-2808
Is Sole Proprietor?:No
Enumeration Date:2008-08-29
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.002782RX363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0068334Medicaid
KY7100061610Medicaid
OH0068334Medicaid