Provider Demographics
NPI:1609570563
Name:ADVANCED CLINICAL CONSULTANTS PLLC
Entity Type:Organization
Organization Name:ADVANCED CLINICAL CONSULTANTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WARE
Authorized Official - Suffix:JR
Authorized Official - Credentials:NP
Authorized Official - Phone:606-448-0693
Mailing Address - Street 1:24 OLD SOUTH FORK RD
Mailing Address - Street 2:
Mailing Address - City:KINGS MOUNTAIN
Mailing Address - State:KY
Mailing Address - Zip Code:40442-9702
Mailing Address - Country:US
Mailing Address - Phone:606-448-0693
Mailing Address - Fax:
Practice Address - Street 1:24 OLD SOUTH FORK RD
Practice Address - Street 2:
Practice Address - City:KINGS MOUNTAIN
Practice Address - State:KY
Practice Address - Zip Code:40442-9702
Practice Address - Country:US
Practice Address - Phone:606-448-0693
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No364SH0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHome HealthGroup - Multi-Specialty