Healthcare Provider Details

I. General information

NPI: 1659235562
Provider Name (Legal Business Name): JOHNATHAN LOWELL MCCLANAHAN BSN, RN, VA-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 NEVILLE ST
BECKLEY WV
25801-4324
US

IV. Provider business mailing address

PO BOX 104
PRINCE WV
25907-0104
US

V. Phone/Fax

Practice location:
  • Phone: 304-673-9296
  • Fax:
Mailing address:
  • Phone: 304-673-9296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number85945
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: