Provider Demographics
NPI:1871969717
Name:MCLENNAN, CAROL (FNP-C)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:MCLENNAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 MEDICAL PARK DR STE 400
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-9010
Mailing Address - Country:US
Mailing Address - Phone:681-342-3490
Mailing Address - Fax:681-342-3491
Practice Address - Street 1:710 GENESIS BLVD
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-9668
Practice Address - Country:US
Practice Address - Phone:681-342-3490
Practice Address - Fax:681-342-3491
Is Sole Proprietor?:No
Enumeration Date:2015-08-14
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV92122363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily