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General NPI Number Information
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NPI Number | 1972133460
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Entity Type | Organization
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Legal Business Name | FNP4JC, LLC
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Dates
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Enumeration Date | 01/23/2020
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Last Update Date | 06/25/2020
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Provider Practice Location Address
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Address Line | 215 NORTH STREET
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City | WAYNESVILLE
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State | MO
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Zip | 65583
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Country | US
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Telephone | 573-774-6279
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Fax | 573-774-5626
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Provider Business Mailing Address
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Address Line | PO BOX 4475
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City | WAYNESVILLE
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State | MO
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Zip | 65583
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Country | US
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Telephone | 573-528-0273
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Fax | 573-774-5626
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Authorized Official
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Title or Position | FNP-C
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Name | MRS. REBECCA LYNN MCCLAIN
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Credential | MSN, APRN, FNP-C
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Telephone | 573-528-0273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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