Provider Demographics
NPI:1184738338
Name:MCCLURE, DEREK ROBERT (FNP-C)
Entity type:Individual
Prefix:MR
First Name:DEREK
Middle Name:ROBERT
Last Name:MCCLURE
Suffix:
Gender:M
Credentials:FNP-C
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 70
Mailing Address - Street 2:
Mailing Address - City:WEST JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28694-0070
Mailing Address - Country:US
Mailing Address - Phone:336-846-6100
Mailing Address - Fax:336-846-7900
Practice Address - Street 1:952 US HIGHWAY 221 BUS
Practice Address - Street 2:
Practice Address - City:WEST JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28694
Practice Address - Country:US
Practice Address - Phone:336-846-6100
Practice Address - Fax:336-846-7900
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201844363LF0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7003818Medicaid
NCQ41986Medicare UPIN