Provider Demographics
NPI:1659179224
Name:MCCLURE, LEDA KEONNE
Entity type:Individual
Prefix:
First Name:LEDA
Middle Name:KEONNE
Last Name:MCCLURE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 DEEMS RD
Mailing Address - Street 2:
Mailing Address - City:MINERAL WELLS
Mailing Address - State:WV
Mailing Address - Zip Code:26150-6085
Mailing Address - Country:US
Mailing Address - Phone:304-494-9542
Mailing Address - Fax:
Practice Address - Street 1:587 E MAPLE ST
Practice Address - Street 2:
Practice Address - City:DAVISVILLE
Practice Address - State:WV
Practice Address - Zip Code:26142-8815
Practice Address - Country:US
Practice Address - Phone:304-991-2956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant