Provider Demographics
NPI:1366217531
Name:MCCLELLAN, ANDREA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:MCCLELLAN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6331 GLENWAY AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-6301
Mailing Address - Country:US
Mailing Address - Phone:513-346-1270
Mailing Address - Fax:513-346-1281
Practice Address - Street 1:6331 GLENWAY AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-6301
Practice Address - Country:US
Practice Address - Phone:513-346-1270
Practice Address - Fax:513-346-1281
Is Sole Proprietor?:No
Enumeration Date:2023-11-17
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2023152213363LP0808X
OHAPRN.CNP.0035468363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health