Provider Demographics
NPI:1235616459
Name:MCCLINTICK, NATALIE DAWN (NP)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:DAWN
Last Name:MCCLINTICK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:DAWN
Other - Last Name:MROZ, PRATER, HOBBS, AND STEWART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:3600 W BETHEL AVE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-5407
Mailing Address - Country:US
Mailing Address - Phone:800-622-6575
Mailing Address - Fax:
Practice Address - Street 1:2610 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46013-9684
Practice Address - Country:US
Practice Address - Phone:765-683-4400
Practice Address - Fax:765-642-7903
Is Sole Proprietor?:No
Enumeration Date:2018-07-20
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71008142A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN71008142BOtherINDIANA CONTROLLED SUBSTANCE REGISTRATION
INF0718507OtherAMERICAN ACADEMY OF NURSE PRACTITIONER NATIONAL CERTIFICATION BOARD, INC.
IN28157223AOtherREGISTERED NURSE
IN71008142AOtherADVANCED NURSE PRACTITIONER