MEDICARE: KATHERINE LYNN MCCLANAHAN D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208M00000X	Hospitalist Physician	20A7842	CA
2	208M00000X	Hospitalist Physician	50707	CO
3	207R00000X	Internal Medicine Physician	1211	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467425884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE LYNN MCCLANAHAN D.O.

Provider Business Mailing Address
First Line	:	P.O. BOX 34046
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-4046
Country	:	US
Telephone Number	:	702-787-7524
Fax Number	:	702-228-0385

Provider Business Practice Location Address
First Line	:	10624 S EASTERN AVE # A-955
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-2982
Country	:	US
Telephone Number	:	702-800-5393
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	12/09/2019

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