Healthcare Provider Details

I. General information

NPI: 1619036498
Provider Name (Legal Business Name): MCLEAN & D G CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2006
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 E 16TH ST
HOPE AR
71801-7424
US

IV. Provider business mailing address

104 E 16TH ST
HOPE AR
71801-7424
US

V. Phone/Fax

Practice location:
  • Phone: 870-777-0007
  • Fax: 870-777-0061
Mailing address:
  • Phone: 870-777-0007
  • Fax: 870-777-0061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberA01251
License Number StateAR

VIII. Authorized Official

Name: MRS. JOAN A MCLEAN
Title or Position: NURSE PRACTIONER
Credential: ANP
Phone: 870-777-0007