Provider Demographics
NPI:1003044181
Name:MCCLARY, JUDY R (RN, PHD, CLNC)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:R
Last Name:MCCLARY
Suffix:
Gender:F
Credentials:RN, PHD, CLNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 THRASHER RD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4726
Mailing Address - Country:US
Mailing Address - Phone:757-436-2326
Mailing Address - Fax:757-410-0891
Practice Address - Street 1:140 THRASHER RD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4726
Practice Address - Country:US
Practice Address - Phone:757-436-2326
Practice Address - Fax:757-410-0891
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-26
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001111488163W00000X, 163WP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WP0000XNursing Service ProvidersRegistered NursePain Management