Healthcare Provider Details

I. General information

NPI: 1104781533
Provider Name (Legal Business Name): JAY CEE MCCLAIN LVN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 BROAD ST
WICHITA FALLS TX
76301-2219
US

IV. Provider business mailing address

207 BROAD ST
WICHITA FALLS TX
76301-2219
US

V. Phone/Fax

Practice location:
  • Phone: 940-500-4903
  • Fax: 940-500-4903
Mailing address:
  • Phone: 940-500-4903
  • Fax: 940-500-4903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number142279
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: