Provider Demographics
NPI:1942812334
Name:CLERMONT, MANACEY (PA-C)
Entity type:Individual
Prefix:
First Name:MANACEY
Middle Name:
Last Name:CLERMONT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7125 E CESAR CHAVEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS
Mailing Address - State:AZ
Mailing Address - Zip Code:85349
Mailing Address - Country:US
Mailing Address - Phone:928-627-8871
Mailing Address - Fax:
Practice Address - Street 1:7125 E CESAR CHAVEZ BLVD
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85349
Practice Address - Country:US
Practice Address - Phone:928-627-8871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-18
Last Update Date:2025-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8534363A00000X
FLPACN63363AM0700X
PR000682-P.A.363AM0700X
NC0010-11839363A00000X
NJ036933363A00000X
INCV21021471021363A00000X
NHEL07785363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical