Provider Demographics
NPI:1538973128
Name:MCCLOUD, MARY BETH (PHD, FNP-BC)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:BETH
Last Name:MCCLOUD
Suffix:
Gender:F
Credentials:PHD, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10929 KNOBLEY RD
Mailing Address - Street 2:
Mailing Address - City:KEYSER
Mailing Address - State:WV
Mailing Address - Zip Code:26726-6868
Mailing Address - Country:US
Mailing Address - Phone:304-790-1614
Mailing Address - Fax:
Practice Address - Street 1:10929 KNOBLEY RD
Practice Address - Street 2:
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726-6868
Practice Address - Country:US
Practice Address - Phone:304-790-1614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV122015363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care