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General NPI Number Information
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NPI Number | 1477348704
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Entity Type | Individual
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Provider Name | KEVIN MCCLELLAN RVS, RCS
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Gender | Male
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Dates
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Enumeration Date | 04/09/2025
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Last Update Date | 04/09/2025
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Provider Practice Location Address
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Address Line | 307 GRISHAM RD
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City | ROYAL
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State | AR
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Zip | 71968-9565
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Country | US
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Telephone | 501-276-6557
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 377
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City | ROYAL
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State | AR
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Zip | 71968-0377
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Country | US
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Telephone | 501-276-6557
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2471V0105X
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Taxonomy Name | Vascular Sonography Radiologic Technologist
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License Number | 00066276
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License Number State | AR
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