Individual
MELISSA L CLARY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1709 EAST BLVD, CHARLOTTE, NC 28203-5823
(704) 333-6642
(704) 332-6642
Mailing address
100 HAWTHORN LN, DANIELS, WV 25832-9269
(304) 763-8555
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
01237
WV
363AM0700X
Medical Physician Assistant
Primary
0010-03356
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001913138
MS BCBS
WV
05
—
3810007173
—
WV
Enumeration date
10/20/2006
Last updated
03/23/2012
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