Provider Demographics
NPI:1245002427
Name:MCCLOUD, DEEANNIA ARYEL
Entity type:Individual
Prefix:
First Name:DEEANNIA
Middle Name:ARYEL
Last Name:MCCLOUD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 MOUNTAIN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:KEYSER
Mailing Address - State:WV
Mailing Address - Zip Code:26726-8235
Mailing Address - Country:US
Mailing Address - Phone:304-788-5467
Mailing Address - Fax:304-788-6363
Practice Address - Street 1:174 MOUNTAIN VIEW DR
Practice Address - Street 2:
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726-8235
Practice Address - Country:US
Practice Address - Phone:304-788-5467
Practice Address - Fax:304-788-6363
Is Sole Proprietor?:No
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant