Provider Demographics
NPI:1558961896
Name:MCCLELLAN, BEVERLY LYNN
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:LYNN
Last Name:MCCLELLAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2378 RIGHT FORK WILSON CREEK RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:WV
Mailing Address - Zip Code:25570-5215
Mailing Address - Country:US
Mailing Address - Phone:304-272-2308
Mailing Address - Fax:
Practice Address - Street 1:2378 RIGHT FORK WILSON CREEK RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:WV
Practice Address - Zip Code:25570-5215
Practice Address - Country:US
Practice Address - Phone:304-272-2308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant