Individual
JOHN W MCCLELLAN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1015 N ELM ST, HENDERSON, KY 42420-2712
(270) 826-8009
(270) 826-7010
Mailing address
1015 N ELM ST, HENDERSON, KY 42420-2712
(270) 826-8009
(270) 826-7010
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
13012
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000041669
ANTHEM
KY
01
—
000000609932
ANTHEM BLUE SHIELD
KY
01
—
080113192
RR MEDICARE
KY
05
—
64130123
—
KY
Enumeration date
04/10/2006
Last updated
02/10/2015
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