Healthcare Provider Details

I. General information

NPI: 1285636282
Provider Name (Legal Business Name): PATRICIA MCCLAIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 UNION CHURCH RD
MEADVILLE MS
39653-8336
US

IV. Provider business mailing address

1260 SPAYD RD
LORMAN MS
39096-6250
US

V. Phone/Fax

Practice location:
  • Phone: 601-384-8100
  • Fax: 601-384-4100
Mailing address:
  • Phone: 601-384-8100
  • Fax: 601-384-4100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR099060
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: