Provider Demographics
NPI:1104894641
Name:MCCLANAHAN, PAGE S (APRN)
Entity type:Individual
Prefix:MRS
First Name:PAGE
Middle Name:S
Last Name:MCCLANAHAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2811 W MARKET ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-5127
Mailing Address - Country:US
Mailing Address - Phone:423-928-2135
Mailing Address - Fax:423-928-5814
Practice Address - Street 1:2811 W MARKET ST
Practice Address - Street 2:SUITE 1
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-5127
Practice Address - Country:US
Practice Address - Phone:423-928-2135
Practice Address - Fax:423-928-5814
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000007340363LF0000X, 363L00000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4117461OtherBLUE CROSS BLUE SHIELD PR
TNS38976Medicare UPIN
TN3343648Medicare PIN