Provider Demographics
NPI:1639316003
Name:MCCLURG, ALYSSA J (FNP)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:J
Last Name:MCCLURG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:JUNE
Other - Last Name:BOSWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:4863 N NEVADA AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-3951
Mailing Address - Country:US
Mailing Address - Phone:719-632-5700
Mailing Address - Fax:719-260-1821
Practice Address - Street 1:4863 N NEVADA AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3951
Practice Address - Country:US
Practice Address - Phone:719-632-5700
Practice Address - Fax:719-260-1821
Is Sole Proprietor?:No
Enumeration Date:2009-01-07
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO991898363LF0000X
CO179969163W00000X
COAPN.0991898-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO24175552Medicaid