Healthcare Provider Details

I. General information

NPI: 1649111394
Provider Name (Legal Business Name): BOYCE MCCLELLAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2026
Last Update Date: 04/04/2026
Certification Date: 04/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 STRIBLING AVE
CHARLOTTESVILLE VA
22903-2942
US

IV. Provider business mailing address

221 STRIBLING AVE
CHARLOTTESVILLE VA
22903-2942
US

V. Phone/Fax

Practice location:
  • Phone: 434-924-2288
  • Fax:
Mailing address:
  • Phone: 434-924-2288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number0001256399
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: