Corissa McClure
Individual provider Active NPI Registered Nurse · Shaw, MS
NPI 1497572986 · NPPES record last updated Sep 25, 2024
Key facts
- NPI
- 1497572986
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 925891 (MS)
- Practice address
- 138 E Peeler Ave
Ste 277 PMB 1004
Shaw, MS 38773 - Phone
- (662) 931-2797
- NPI assigned
- Sep 25, 2024
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 925891 | MS | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 925891 | MS | Yes |
Addresses
Primary practice location
138 E Peeler Ave
Ste 277 PMB 1004
Shaw, MS 38773
Mailing address
138 E Peeler Ave
Ste 277 PMB 1004
Shaw, MS 38773
Other providers in Shaw, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 25, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.