Provider Demographics
NPI:1578989463
Name:DEREK MCCLURE
Entity type:Organization
Organization Name:DEREK MCCLURE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLURE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:336-846-6100
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:WEST JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28694-0070
Mailing Address - Country:US
Mailing Address - Phone:336-846-6100
Mailing Address - Fax:336-846-7900
Practice Address - Street 1:952 US HIGHWAY 221 BUS
Practice Address - Street 2:
Practice Address - City:WEST JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28694-8137
Practice Address - Country:US
Practice Address - Phone:336-846-6100
Practice Address - Fax:336-846-7900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-15
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7003818Medicaid
NC7003818Medicaid