Provider Demographics
NPI:1811744600
Name:MCCLURE, KRISTIN NICOLE (FNP)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:NICOLE
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 1:5267 THAMES CT
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-8347
Mailing Address - Country:US
Mailing Address - Phone:517-414-8810
Mailing Address - Fax:
Practice Address - Street 1:1100 E MICHIGAN AVE STE 204
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1800
Practice Address - Country:US
Practice Address - Phone:517-205-2163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704330357363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily