Healthcare Provider Details

I. General information

NPI: 1982895363
Provider Name (Legal Business Name): TINA LEE MCCALL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TINA LEE BARGER

II. Dates (important events)

Enumeration Date: 08/09/2007
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 W MAIN ST
CABOT AR
72023-2900
US

IV. Provider business mailing address

111 FRONT ST
HENDERSON TN
38340-2313
US

V. Phone/Fax

Practice location:
  • Phone: 731-935-9472
  • Fax:
Mailing address:
  • Phone: 731-989-2829
  • Fax: 731-520-0232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12769
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: