Individual
GERALD W CLEVENGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
311 W. LOCUST ST., TROY, KS 66087
(785) 985-3504
(785) 985-3813
Mailing address
800 RAVENHILL DR, ATCHISON, KS 66002-9204
(913) 367-2131
(913) 674-2024
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1500117
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016289043
PTAN
KS
05
—
100098780E
—
KS
05
—
30004083700001
—
KS
Enumeration date
06/28/2005
Last updated
03/11/2026
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