Provider Demographics
NPI:1922056290
Name:MCCLURE, KAREN L (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:L
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10399
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24543-5007
Mailing Address - Country:US
Mailing Address - Phone:434-792-3730
Mailing Address - Fax:434-792-6048
Practice Address - Street 1:501 RISON ST
Practice Address - Street 2:SUITE 120
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-2425
Practice Address - Country:US
Practice Address - Phone:434-792-3730
Practice Address - Fax:434-792-6048
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024158518363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010241111Medicaid
VA010241111Medicaid
VA00W571D04Medicare PIN