Provider Demographics
NPI:1619212891
Name:MCCALL, MABLE CLAIRE (FNP)
Entity Type:Individual
Prefix:MS
First Name:MABLE
Middle Name:CLAIRE
Last Name:MCCALL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4105 JUNIUS STREET
Mailing Address - Street 2:AGAPE CLINIC
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246
Mailing Address - Country:US
Mailing Address - Phone:214-824-2744
Mailing Address - Fax:214-823-9952
Practice Address - Street 1:4105 JUNIUS STREET
Practice Address - Street 2:AGAPE CLINIC @ GUMC
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246
Practice Address - Country:US
Practice Address - Phone:214-824-2744
Practice Address - Fax:214-823-9952
Is Sole Proprietor?:No
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5700063163WC1500X, 163WP2201X, 163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory