Provider Demographics
NPI:1457908261
Name:MCCLURE, SEAN (FNP)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:MCCLURE
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 HIGHLAND RIDGE DR APT 2B
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66503-0409
Mailing Address - Country:US
Mailing Address - Phone:785-565-3141
Mailing Address - Fax:
Practice Address - Street 1:2770 S 9TH ST
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-7601
Practice Address - Country:US
Practice Address - Phone:785-565-3141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-78909-062363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily