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General NPI Number Information
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NPI Number | 1962879445
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Entity Type | Individual
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Provider Name | CEDRIC MCCLINTON NP
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Gender | Male
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Dates
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Enumeration Date | 08/31/2015
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Last Update Date | 09/06/2024
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Provider Practice Location Address
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Address Line | 4475 S EASTERN AVE
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City | LAS VEGAS
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State | NV
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Zip | 89119
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Country | US
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Telephone | 702-877-5199
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 35380
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City | LAS VEGAS
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State | NV
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Zip | 89133-5380
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Country | US
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Telephone | 702-877-5199
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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 | AP128908
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP128908
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 819041
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License Number State | NV
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