1538672373 NPI number — MICHELE MCCLURE APRN

Table of content: MICHELE MCCLURE APRN (NPI 1538672373)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538672373 NPI number — MICHELE MCCLURE APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCLURE
Provider First Name:
MICHELE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DARNELL
Provider Other First Name:
MICHELE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1538672373
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 21890
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELFAST
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04915-4115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-907-0356
Provider Business Mailing Address Fax Number:
502-919-9780

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 EXECUTIVE PARK
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40207-4201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-855-7200
Provider Business Practice Location Address Fax Number:
502-855-7201
Provider Enumeration Date:
11/15/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  71007764A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: 3012101 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 300013667 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: CS1823600597 . This is a "CARESOURCE PROVIDER ID NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: PDZ000000076638 . This is a "AETNA BETTER HEALTH OF KY PROVIDER ID NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000001171736 . This is a "ANTHEM PROVIDER ID NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6570412 . This is a "AETNA PROVIDER ID NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7100533270 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1594354 . This is a "WELLCARE OF KY PROVIDER ID NUMBER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 14216057 . This is a "CAQH PROVIDER ID" identifier . This identifiers is of the category "OTHER".




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