Provider Demographics
NPI:1568724300
Name:MCLEAN, JENNIFER ANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANNE
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-5021
Mailing Address - Country:US
Mailing Address - Phone:214-644-0280
Mailing Address - Fax:214-644-0294
Practice Address - Street 1:919 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-5021
Practice Address - Country:US
Practice Address - Phone:214-644-0280
Practice Address - Fax:214-644-0294
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06097363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX129982807Medicaid