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NPI Code Detail

MEDICARE: MS. JENNIFER LOUISE MCCLUNG PRSS

MEDICARE: MS. JENNIFER LOUISE MCCLUNG PRSS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1175T00000XPeer SpecialistWV

General Provider Information

NPI Number : 1104550383
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JENNIFER LOUISE MCCLUNG PRSS
Provider Business Mailing Address
First Line : 1073 ARBUCKLE RD
Second Line :
City : SUMMERSVILLE
State : WV
Zip : 26651-1745
Country : US
Telephone Number : 304-362-0295
Fax Number : 304-883-0141
Provider Business Practice Location Address
First Line : 1073 ARBUCKLE RD
Second Line :
City : SUMMERSVILLE
State : WV
Zip : 26651-1745
Country : US
Telephone Number : 304-362-0295
Fax Number : 304-883-0141
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2022
Last Update Date : 07/13/2022

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Directions to “ MS. JENNIFER LOUISE MCCLUNG PRSS” Practice Location

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