Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Micah Lynn Ann Clutter

Individual provider Athletic Trainer · NPI 1053948521

Micah Lynn Ann Clutter is a Physician Assistant in Rockford, Illinois. Qualified in 2020, 6 years ago. Practices with Orthopaedic Associates of Wisconsin SC, a 106-clinician group and accepts Medicare assignment. Licensed in Illinois.

Years since qualifying
6
Licensed in
IL
In the registry since
2020
Specialties on file
2
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Practice location Address checks out

324 Roxbury Rd
Rockford, IL 61107-5090
Phone: (815) 398-9491
Fax: (815) 381-7498
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 085-007766 (IL)
Athletic Trainer Taxonomy 2255A2300X

Record details

NPI number1053948521
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedMarch 25, 2020
Last updated in NPPESJuly 30, 2020
Certification dateJuly 30, 2020
Mailing addressBox 78534, Milwaukee, WI 53278-8534

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Orthopaedic Associates Of Wisconsin Sc — 106 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

Other providers in Rockford