Healthcare Provider Details

I. General information

NPI: 1861925331
Provider Name (Legal Business Name): KASEY LEIGH MCCLAIN APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 10/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2280 E MAIN ST
EL DORADO AR
71730
US

IV. Provider business mailing address

4172 S JACKSON AVE
EL DORADO AR
71730-2028
US

V. Phone/Fax

Practice location:
  • Phone: 870-444-5216
  • Fax: 870-895-2164
Mailing address:
  • Phone: 870-818-2666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA005215
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: