Provider Demographics
NPI:1164408886
Name:MCCLELLAN, RICKEY A (MD)
Entity Type:Individual
Prefix:DR
First Name:RICKEY
Middle Name:A
Last Name:MCCLELLAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2917
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502-2917
Mailing Address - Country:US
Mailing Address - Phone:606-218-1000
Mailing Address - Fax:606-218-7507
Practice Address - Street 1:911 BYPASS RD
Practice Address - Street 2:7TH FLOOR CLINIC
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1689
Practice Address - Country:US
Practice Address - Phone:606-218-1000
Practice Address - Fax:606-218-7507
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY25954207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64259542Medicaid
KY25954OtherMEDICAL LICENSE NUMBER
KY25954OtherMEDICAL LICENSE NUMBER
KYK033220Medicare PIN
E01373Medicare UPIN
KY1526201Medicare ID - Type Unspecified