Healthcare Provider Details

I. General information

NPI: 1871955880
Provider Name (Legal Business Name): DR. JESSICA MCCLANAHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2709 BAY CEDAR CV
LEXINGTON KY
40511-8864
US

IV. Provider business mailing address

2393 ALUMNI DR STE 102
LEXINGTON KY
40517-4285
US

V. Phone/Fax

Practice location:
  • Phone: 859-317-0393
  • Fax:
Mailing address:
  • Phone: 859-317-0393
  • Fax: 859-327-3184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9735
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: