Provider Demographics
NPI:1790771954
Name:MCCLAIN, DAVID L (ARNP)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:L
Last Name:MCCLAIN
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 SHELTON LN
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42276-7203
Mailing Address - Country:US
Mailing Address - Phone:270-632-4514
Mailing Address - Fax:270-632-4518
Practice Address - Street 1:60 SHELTON LN
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:KY
Practice Address - Zip Code:42276-7203
Practice Address - Country:US
Practice Address - Phone:270-632-4514
Practice Address - Fax:270-632-4518
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2134P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78010121Medicaid
183859Medicare PIN
KYS78411Medicare UPIN