Provider Demographics
NPI:1588812010
Name:MCCLAIN, JENNIE M (RN,DNP, FNP-BC)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:M
Last Name:MCCLAIN
Suffix:
Gender:F
Credentials:RN,DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:207 W HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-2427
Mailing Address - Country:US
Mailing Address - Phone:740-392-1181
Mailing Address - Fax:740-392-1180
Practice Address - Street 1:207 W HIGH ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-2427
Practice Address - Country:US
Practice Address - Phone:740-392-1181
Practice Address - Fax:740-392-1180
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28108786A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily