Provider Demographics
NPI:1194217273
Name:MCCLARD, SHANA MICHELLE (RD)
Entity Type:Individual
Prefix:MRS
First Name:SHANA
Middle Name:MICHELLE
Last Name:MCCLARD
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82D MDG
Mailing Address - Street 2:527 TUSKEGEE AIRMEN AVE
Mailing Address - City:SHEPPARD
Mailing Address - State:TX
Mailing Address - Zip Code:76311
Mailing Address - Country:US
Mailing Address - Phone:940-676-1693
Mailing Address - Fax:
Practice Address - Street 1:82D MDG
Practice Address - Street 2:527 TUSKEGEE AIRMEN AVE
Practice Address - City:SHEPPARD
Practice Address - State:TX
Practice Address - Zip Code:76311
Practice Address - Country:US
Practice Address - Phone:940-676-1693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNCHH907420325OtherBCBS