Provider Demographics
NPI:1427899335
Name:MCGLOTHLIN, MARSHALL (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:MARSHALL
Middle Name:
Last Name:MCGLOTHLIN
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 CEDAR VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR BLUFF
Mailing Address - State:VA
Mailing Address - Zip Code:24609-9190
Mailing Address - Country:US
Mailing Address - Phone:276-821-2260
Mailing Address - Fax:
Practice Address - Street 1:1113 CEDAR VALLEY DR
Practice Address - Street 2:
Practice Address - City:CEDAR BLUFF
Practice Address - State:VA
Practice Address - Zip Code:24609-9190
Practice Address - Country:US
Practice Address - Phone:276-821-2260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024190320363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health