Individual
MS. CHRYSTELL LAURA CLUCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
330 BILLINGSLEY RD STE 205, CHARLOTTE, NC 28211-5020
(704) 333-9113
(980) 217-7243
Mailing address
2016 SCOTT AVE, CHARLOTTE, NC 28203-6048
(252) 917-2563
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-08301
NC
Other
Enumeration date
10/23/2018
Last updated
10/09/2024
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