Provider Demographics
NPI:1760849194
Name:MCCLURE, SANDRA K (APRN)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:K
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 690
Mailing Address - Street 2:
Mailing Address - City:BEATTYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41311-0690
Mailing Address - Country:US
Mailing Address - Phone:606-743-4808
Mailing Address - Fax:606-743-4716
Practice Address - Street 1:1219 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST LIBERTY
Practice Address - State:KY
Practice Address - Zip Code:41472-2161
Practice Address - Country:US
Practice Address - Phone:606-743-4808
Practice Address - Fax:606-743-4716
Is Sole Proprietor?:No
Enumeration Date:2016-01-15
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3009957363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3009957OtherAPRN LICENSURE
KY7100401070Medicaid
KYK185732Medicare PIN