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General NPI Number Information
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NPI Number | 1568822799
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Entity Type | Individual
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Provider Name | GLORIA JEAN MCCLAIN NP-C
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Gender | Female
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Dates
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Enumeration Date | 03/01/2016
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Last Update Date | 08/02/2023
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Provider Practice Location Address
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Address Line | 218 MAIN STREET
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City | FULTON
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State | AL
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Zip | 36446-0065
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Country | US
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Telephone | 334-636-4823
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Fax | 334-636-1702
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Provider Business Mailing Address
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Address Line | 24B CAMDEN BYP
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City | CAMDEN
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State | AL
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Zip | 36726-1770
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Country | US
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Telephone | 334-882-1919
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1-101377
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License Number State | AL
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