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
StateLicense IDTaxonomies
KS74371363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200517980AMedicaid
KS74371OtherLICENSE NUMBER
KSQ75023Medicare UPIN
KS161999Medicare PIN