Healthcare Provider Details

I. General information

NPI: 1841008984
Provider Name (Legal Business Name): JESSICA MARIE MCCLUNG CNP
Entity Type: Individual
Gender:
Sole Proprietor: Y

Provider Other Name: JESSICA MARIE KERR CNP

II. Dates (important events)

Enumeration Date: 12/20/2024
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 UNSER BLVD SE
RIO RANCHO NM
87124-3392
US

IV. Provider business mailing address

1003 GRACE ST NE
ALBUQUERQUE NM
87112-5607
US

V. Phone/Fax

Practice location:
  • Phone: 505-253-6100
  • Fax:
Mailing address:
  • Phone: 505-400-5818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number82098
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: