Provider Demographics
NPI:1538672373
Name:MCCLURE, MICHELE (APRN)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:DARNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 21890
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4115
Mailing Address - Country:US
Mailing Address - Phone:502-907-0356
Mailing Address - Fax:502-919-9780
Practice Address - Street 1:120 EXECUTIVE PARK
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4201
Practice Address - Country:US
Practice Address - Phone:502-855-7200
Practice Address - Fax:502-855-7201
Is Sole Proprietor?:No
Enumeration Date:2017-11-15
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71007764A363LA2200X
KY3012101363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300013667Medicaid
CS1823600597OtherCARESOURCE PROVIDER ID NUMBER
PDZ000000076638OtherAETNA BETTER HEALTH OF KY PROVIDER ID NUMBER
000001171736OtherANTHEM PROVIDER ID NUMBER
6570412OtherAETNA PROVIDER ID NUMBER
KY7100533270Medicaid
KY1594354OtherWELLCARE OF KY PROVIDER ID NUMBER
14216057OtherCAQH PROVIDER ID