Healthcare Provider Details

I. General information

NPI: 1083472955
Provider Name (Legal Business Name): RACHEL ANN MCCLANAHAN CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2024
Last Update Date: 04/12/2024
Certification Date: 04/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

656 INDEPENDENCE PKWY
CHESAPEAKE VA
23320-5213
US

IV. Provider business mailing address

105 STEPPESIDE LN
MOYOCK NC
27958-6510
US

V. Phone/Fax

Practice location:
  • Phone: 757-410-3630
  • Fax:
Mailing address:
  • Phone: 757-376-3156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0024187778
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0024187778
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: