Provider Demographics
NPI:1528427408
Name:MCCLENDON, ASHLEY NICHOLE (PA-C)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:NICHOLE
Last Name:MCCLENDON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1847 S LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-7759
Mailing Address - Country:US
Mailing Address - Phone:803-356-8998
Mailing Address - Fax:803-356-8999
Practice Address - Street 1:1847 S LAKE DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29073-7759
Practice Address - Country:US
Practice Address - Phone:803-356-8998
Practice Address - Fax:803-356-8999
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-19
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2502363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3000PAMedicaid
SC423828OtherMEDICARE RURAL
SCPC4116Medicaid
SCRHC020Medicaid
SC428926OtherMEDICARE RURAL
SCRHC151Medicaid
SC3000PAMedicaid