Provider Demographics
NPI:1720888092
Name:MCCLEAVE FRANCIS, FAWN (LMT)
Entity type:Individual
Prefix:
First Name:FAWN
Middle Name:
Last Name:MCCLEAVE FRANCIS
Suffix:
Gender:
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39180-3549
Mailing Address - Country:US
Mailing Address - Phone:601-868-0871
Mailing Address - Fax:
Practice Address - Street 1:1703 MONROE ST
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-3549
Practice Address - Country:US
Practice Address - Phone:601-868-0871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS816225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty