Provider Demographics
NPI:1588800189
Name:MCCLURKIN, SHANNON K (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:K
Last Name:MCCLURKIN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:KIA
Other - Last Name:BARKLEY ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 650782
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0782
Mailing Address - Country:US
Mailing Address - Phone:302-733-0806
Mailing Address - Fax:302-733-0854
Practice Address - Street 1:175 E. CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:RIDLEY PARK
Practice Address - State:PA
Practice Address - Zip Code:19078-2284
Practice Address - Country:US
Practice Address - Phone:215-442-5085
Practice Address - Fax:877-329-2370
Is Sole Proprietor?:No
Enumeration Date:2009-01-02
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN550491367500000X
DEL1-0029265367500000X
NJ26NR13142900367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA079043OtherAANA
PA102309550Medicaid
PA102309550Medicaid