Healthcare Provider Details

I. General information

NPI: 1922056290
Provider Name (Legal Business Name): KAREN L MCCLURE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 12/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 RISON ST SUITE 120
DANVILLE VA
24541-2425
US

IV. Provider business mailing address

PO BOX 10399
DANVILLE VA
24543-5007
US

V. Phone/Fax

Practice location:
  • Phone: 434-792-3730
  • Fax: 434-792-6048
Mailing address:
  • Phone: 434-792-3730
  • Fax: 434-792-6048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024158518
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: