MEDICARE: NICOLE MCCLAIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LW0102X	Women's Health Nurse Practitioner	5376893052	KS
2	363LW0102X	Women's Health Nurse Practitioner	2015035374	MO

General Provider Information

NPI Number	:	1467818856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE MCCLAIN

Provider Business Mailing Address
First Line	:	11875 S SUNSET DR
Second Line	:
City	:	OLATHE
State	:	KS
Zip	:	66061-2793
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11875 S SUNSET DR
Second Line	:
City	:	OLATHE
State	:	KS
Zip	:	66061-2793
Country	:	US
Telephone Number	:	913-826-1200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2016
Last Update Date	:	06/27/2016

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