Provider Demographics
NPI:1841958089
Name:MCCLURE, REGINA ALYSE (APRN, WHNP-BC)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:ALYSE
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:APRN, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2432 GRAND RAPIDS DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76177-8585
Mailing Address - Country:US
Mailing Address - Phone:915-269-8847
Mailing Address - Fax:
Practice Address - Street 1:3912 N TARRANT PKWY STE 204
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-5413
Practice Address - Country:US
Practice Address - Phone:817-431-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1054197363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health