Healthcare Provider Details

I. General information

NPI: 1366506651
Provider Name (Legal Business Name): JULIE KAY MCCLAREN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIE KAY GOOD ARNP

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 05/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3515 BROADWAY AVE SUITE 121
GREAT BEND KS
67530-3633
US

IV. Provider business mailing address

PO BOX 309
GREAT BEND KS
67530-0309
US

V. Phone/Fax

Practice location:
  • Phone: 620-793-5510
  • Fax: 620-793-5601
Mailing address:
  • Phone: 620-786-6475
  • Fax: 620-786-6155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number74371
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: