Provider Demographics
NPI:1447738265
Name:CLEVIDENCE, MACY LURA THOMPSON (APRN FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:MACY
Middle Name:LURA THOMPSON
Last Name:CLEVIDENCE
Suffix:
Gender:F
Credentials:APRN FNP-C
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 134
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42461-0134
Mailing Address - Country:US
Mailing Address - Phone:270-952-6025
Mailing Address - Fax:
Practice Address - Street 1:1284 US HIGHWAY 60 W
Practice Address - Street 2:
Practice Address - City:MORGANFIELD
Practice Address - State:KY
Practice Address - Zip Code:42437
Practice Address - Country:US
Practice Address - Phone:270-389-2323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3012486363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily