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Individual
KELLY A CLINTON
Active
Individual
KELLY A CLINTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA04635
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1067023
NCCPA
TX
05
—
280826301
—
TX
05
—
280826302
—
TX
05
—
280826303
—
TX
01
—
8Y0105
BCBS
TX
01
—
P01057828
RAILROAD MEDICARE
TX
Enumeration date
05/26/2006
Last updated
09/11/2012
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