Healthcare Provider Details

I. General information

NPI: 1528490224
Provider Name (Legal Business Name): CHRISTINA M MCCLAIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2013
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2610 ENTERPRISE DR
ANDERSON IN
46013-9684
US

IV. Provider business mailing address

3600 W BETHEL AVE
MUNCIE IN
47304-5407
US

V. Phone/Fax

Practice location:
  • Phone: 800-622-6575
  • Fax:
Mailing address:
  • Phone: 800-622-6575
  • Fax: 765-287-8720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number10001582A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: