Provider Demographics
NPI:1558656876
Name:MCCLINTOCK, HOLLY A (ARNP)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:A
Last Name:MCCLINTOCK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3049 19TH AVE N
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-7872
Mailing Address - Country:US
Mailing Address - Phone:515-574-9803
Mailing Address - Fax:949-862-3765
Practice Address - Street 1:531 S 29TH ST STE 1
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-5503
Practice Address - Country:US
Practice Address - Phone:515-302-8072
Practice Address - Fax:949-862-3765
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG-122426363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health