Provider Demographics
NPI:1275672909
Name:MCCLANAHAN, PATSY H (CNP)
Entity Type:Individual
Prefix:MRS
First Name:PATSY
Middle Name:H
Last Name:MCCLANAHAN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3326 FRONT ST STE B
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:LA
Mailing Address - Zip Code:71295-6487
Mailing Address - Country:US
Mailing Address - Phone:318-435-7333
Mailing Address - Fax:318-435-9061
Practice Address - Street 1:3326 FRONT ST STE B
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:LA
Practice Address - Zip Code:71295-6487
Practice Address - Country:US
Practice Address - Phone:318-435-7333
Practice Address - Fax:318-435-9061
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN035479-1166363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1690228Medicaid
LA5X061F600Medicare PIN
LAS29743Medicare UPIN