Healthcare Provider Details

I. General information

NPI: 1508476847
Provider Name (Legal Business Name): MRS. DEANN MARIE MCCLELLAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2020
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W 24TH ST
KEARNEY NE
68847-5358
US

IV. Provider business mailing address

PO BOX 1210
KEARNEY NE
68848-1210
US

V. Phone/Fax

Practice location:
  • Phone: 308-865-2740
  • Fax:
Mailing address:
  • Phone: 308-865-2740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number113250
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number113250
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: