Provider Demographics
NPI:1235791963
Name:MCCLANAHAN, Y'MINE MICHAEL (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:MISS
First Name:Y'MINE
Middle Name:MICHAEL
Last Name:MCCLANAHAN
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59101 AMBER ST
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-3708
Mailing Address - Country:US
Mailing Address - Phone:985-646-1580
Mailing Address - Fax:888-863-4274
Practice Address - Street 1:106 MIMOSA ST
Practice Address - Street 2:
Practice Address - City:AMITE
Practice Address - State:LA
Practice Address - Zip Code:70422-2136
Practice Address - Country:US
Practice Address - Phone:985-247-2411
Practice Address - Fax:844-856-3736
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA206489363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily