Provider Demographics
NPI:1407503006
Name:MCCLURE, NICOLE DENAE (NP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:DENAE
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 LOIS LN
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:26181-8605
Mailing Address - Country:US
Mailing Address - Phone:174-049-1027
Mailing Address - Fax:
Practice Address - Street 1:285 AVIATION DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:WV
Practice Address - Zip Code:26187-7951
Practice Address - Country:US
Practice Address - Phone:740-491-0278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-04
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV111276207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine