Provider Demographics
NPI:1073107546
Name:MCCLUNG, RACHEL
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:MCCLUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3877 YOUNGS MONUMENT RD
Mailing Address - Street 2:
Mailing Address - City:DILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26617-9721
Mailing Address - Country:US
Mailing Address - Phone:304-332-5518
Mailing Address - Fax:
Practice Address - Street 1:3877 YOUNGS MONUMENT RD
Practice Address - Street 2:
Practice Address - City:DILLE
Practice Address - State:WV
Practice Address - Zip Code:26617-9721
Practice Address - Country:US
Practice Address - Phone:304-332-5518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker