Provider Demographics
NPI:1316995459
Name:MCCLURE, SHELLEY A (MD)
Entity type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:A
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 WALTON RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-4215
Mailing Address - Country:US
Mailing Address - Phone:620-218-1622
Mailing Address - Fax:
Practice Address - Street 1:110 HILLTOP ST
Practice Address - Street 2:
Practice Address - City:CONNELLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:28612
Practice Address - Country:US
Practice Address - Phone:828-580-7432
Practice Address - Fax:620-402-5044
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9900602207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS014013Medicare ID - Type UnspecifiedMEDICARE
KS111155OtherBLUE CROSS BLUE SHIELD
KSG27205Medicare UPIN
KS014013OtherBLUE SHIELD
KS200312430AMedicaid
KS014013OtherBLUE SHIELD