Kevin Clancy, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

6943 Issued in AZ

Practice address

3250 W Lower Buckeye Rd
Phoenix, AZ 85009-6729

Phone

(602) 579-3846

NPI assigned

Oct 26, 2017

Sex

Male

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

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1508976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587945600000",
    "number": "1871005140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 S 4TH AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850032138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3250 W LOWER BUCKEYE RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850096729",
            "telephone_number": "602-579-3846"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLANCY",
        "first_name": "KEVIN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-10-26",
        "last_updated": "2020-04-27",
        "certification_date": "2020-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "6943",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Courtney Civelli, MD
• David Civic, MD
• Emily Katherine Claassen, MED, LBA, BCBA
• Alexander Clabourne, RDN
• Alejandra Clamor
• Marilynne Clancy, RN, MS, PNP
• Noreen A. Clancy, LCSW
• Robert J. Clanton, O.D.
• Tiffiny Marie Clapp, RN
• Elizabeth Marie Clapper, MSN, APRN, FNP-C

• Physician Assistant in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.