=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659235562
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHNATHAN LOWELL MCCLANAHAN BSN, RN, VA-BC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/15/2025
-----------------------------------------------------
Last Update Date | 12/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1002 NEVILLE ST
-----------------------------------------------------
City | BECKLEY
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25801-4324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-673-9296
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 104
-----------------------------------------------------
City | PRINCE
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25907-0104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-673-9296
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WI0500X
-----------------------------------------------------
Taxonomy Name | Infusion Therapy Registered Nurse
-----------------------------------------------------
License Number | 85945
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------