Provider Demographics
NPI:1225720014
Name:MCCLURE, STEPHANIE (FNP-C)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 59
Mailing Address - Street 2:
Mailing Address - City:TROUP
Mailing Address - State:TX
Mailing Address - Zip Code:75789-0059
Mailing Address - Country:US
Mailing Address - Phone:903-969-5056
Mailing Address - Fax:903-969-5059
Practice Address - Street 1:400 W. CALVERT STREET
Practice Address - Street 2:UNIT C
Practice Address - City:TROUP
Practice Address - State:TX
Practice Address - Zip Code:75789
Practice Address - Country:US
Practice Address - Phone:903-969-5056
Practice Address - Fax:903-969-5059
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1117628363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily