Healthcare Provider Details

I. General information

NPI: 1467425884
Provider Name (Legal Business Name): KATHERINE LYNN MCCLANAHAN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 12/09/2019
Certification Date: 12/09/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10624 S EASTERN AVE # A-955
HENDERSON NV
89052-2982
US

IV. Provider business mailing address

P.O. BOX 34046
LAS VEGAS NV
89133-4046
US

V. Phone/Fax

Practice location:
  • Phone: 702-800-5393
  • Fax:
Mailing address:
  • Phone: 702-787-7524
  • Fax: 702-228-0385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1211
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number20A7842
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number50707
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: