Healthcare Provider Details

I. General information

NPI: 1538118351
Provider Name (Legal Business Name): DIANE KAY MCCLAIN NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 02/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3210 DYER ST
EL PASO TX
79930-6230
US

IV. Provider business mailing address

7080 PORTUGAL DR APT A
EL PASO TX
79912-2345
US

V. Phone/Fax

Practice location:
  • Phone: 915-351-8100
  • Fax:
Mailing address:
  • Phone: 915-313-4969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number241053
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: