Lisa Speede McClure
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Petersburg, VA
NPI 1124715396 · NPPES record last updated Aug 24, 2026
Key facts
- NPI
- 1124715396
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 0024186346 (VA)
- Practice address
- 541 S Sycamore St
Petersburg, VA 23803-5039 - Phone
- (804) 835-6100
- NPI assigned
- Apr 19, 2023
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Southside Behavioral Health
Practice addresses (Care Compare)
523 Madison St
Boydton, VA 23917-3104
Phone (434) 738-0154
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230915000124 | VA | Practitioner - Nurse Practitioner | 5991169583 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0024186346 | VA | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southside Behavioral Health | Current |
Accepting new patients |
Locations
523 Madison St
Boydton, VA 23917
Phone (434) 738-0154
143 Industrial Pkwy
Clarksville, VA 23927
Phone (434) 572-6916
424 Hamilton Blvd
South Boston, VA 24592
Phone (434) 572-2936
823 N Mecklenburg Ave
South Hill, VA 23970
Phone (434) 447-7601
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 0024186346 | VA | Yes |
Addresses
Primary practice location
541 S Sycamore St
Petersburg, VA 23803-5039
Mailing address
257 Triple C Dr
Clarksville, VA 23927-2560
Phone (434) 774-5743
Other providers in Petersburg, VA
- Bria Mays
- Lori Vaughan Mazsure
- Jacqueline Meredith McCabe
- Brian Wayne McCauley
- Brendan D McCay
- Calvin McIntyre
- Lavonne D McLendon
- Angela Aikens McMichael
- Zebrina Meade
- Med-Trans Corporation
All providers in Petersburg, VA · Psychiatric/Mental Health Nurse Practitioner in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 24, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.