Provider Demographics
NPI:1184091563
Name:MCCLURE, TARA (CN-P)
Entity type:Individual
Prefix:MISS
First Name:TARA
Middle Name:
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:CN-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 SLIPPERY ROCK LN
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:OH
Mailing Address - Zip Code:44017-3159
Mailing Address - Country:US
Mailing Address - Phone:216-544-0652
Mailing Address - Fax:
Practice Address - Street 1:109 SLIPPERY ROCK LN
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:OH
Practice Address - Zip Code:44017-3159
Practice Address - Country:US
Practice Address - Phone:216-544-0652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-01
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF0615961363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily