Healthcare Provider Details

I. General information

NPI: 1639034044
Provider Name (Legal Business Name): CATHERINE SIMMONS MCLEAN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 LAUCK DR
WINCHESTER VA
22603-4282
US

IV. Provider business mailing address

153 BROMPTON CT
STEPHENS CITY VA
22655-2519
US

V. Phone/Fax

Practice location:
  • Phone: 999-999-9999
  • Fax:
Mailing address:
  • Phone: 540-631-4314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0024164151
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: