Provider Demographics
NPI: | 1366506651 |
---|---|
Name: | MCCLAREN, JULIE KAY (ARNP) |
Entity Type: | Individual |
Prefix: | |
First Name: | JULIE |
Middle Name: | KAY |
Last Name: | MCCLAREN |
Suffix: | |
Gender: | F |
Credentials: | ARNP |
Other - Prefix: | |
Other - First Name: | JULIE |
Other - Middle Name: | KAY |
Other - Last Name: | GOOD |
Other - Suffix: | |
Other - Last Name Type: | Former Name |
Other - Credentials: | ARNP |
Mailing Address - Street 1: | PO BOX 309 |
Mailing Address - Street 2: | |
Mailing Address - City: | GREAT BEND |
Mailing Address - State: | KS |
Mailing Address - Zip Code: | 67530-0309 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 620-786-6475 |
Mailing Address - Fax: | 620-786-6155 |
Practice Address - Street 1: | 3515 BROADWAY AVE |
Practice Address - Street 2: | SUITE 121 |
Practice Address - City: | GREAT BEND |
Practice Address - State: | KS |
Practice Address - Zip Code: | 67530-3633 |
Practice Address - Country: | US |
Practice Address - Phone: | 620-793-5510 |
Practice Address - Fax: | 620-793-5601 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-12-20 |
Last Update Date: | 2009-05-28 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
KS | 74371 | 363LX0001X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LX0001X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
KS | 200517980A | Medicaid | |
KS | 74371 | Other | LICENSE NUMBER |
KS | Q75023 | Medicare UPIN | |
KS | 161999 | Medicare PIN |