Healthcare Provider Details

I. General information

NPI: 1447738265
Provider Name (Legal Business Name): MACY LURA THOMPSON CLEVIDENCE APRN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2018
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 BARRET BLVD
HENDERSON KY
42420-4950
US

IV. Provider business mailing address

PO BOX 134
UNIONTOWN KY
42461-0134
US

V. Phone/Fax

Practice location:
  • Phone: 270-844-8600
  • Fax: 270-844-8610
Mailing address:
  • Phone: 270-952-6025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3012486
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: