Hailey Smith Clissold, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-13113 Issued in NC

Practice address

1000 Social St Ste 300
Raleigh, NC 27609-2102

Phone

(310) 567-8177

NPI assigned

Jul 19, 2021

Last updated

Sep 11, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1626652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726012800000",
    "number": "1326611419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 SOCIAL ST STE 300",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276092102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 SOCIAL ST STE 300",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276092102",
            "telephone_number": "310-567-8177"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "405 Glascock St",
            "address_purpose": "LOCATION",
            "city": "Raleigh",
            "state": "NC",
            "postal_code": "276042042",
            "country_code": "US",
            "telephone_number": "310-567-8177",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLISSOLD",
        "first_name": "HAILEY",
        "middle_name": "SMITH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-19",
        "last_updated": "2024-09-11",
        "certification_date": "2024-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-13113",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William Tucker Cline, MD
• Madison Clinger
• Clinical Associates Healthcare
• Clinical Healthcare Incorporated
• Richard B Clinton, MD
• Reynolds Clodfelter, Jr.
• Kerry Michelle Clodfelter, LCMHCA
• Rebecca Jeffries Cloer, FNP
• Brian Cloninger
• Tracey S Cloninger, PA-C

• Physician Assistant in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.