Provider Demographics
NPI:1891113262
Name:MCCLINTOCK, SUSAN KATHRYN (APRN)
Entity Type:Individual
Prefix:MISS
First Name:SUSAN
Middle Name:KATHRYN
Last Name:MCCLINTOCK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:405 E COLLIN RAYE DR STE C
Mailing Address - Street 2:
Mailing Address - City:DE QUEEN
Mailing Address - State:AR
Mailing Address - Zip Code:71832-4107
Mailing Address - Country:US
Mailing Address - Phone:866-282-0406
Mailing Address - Fax:866-282-5926
Practice Address - Street 1:405 E COLLIN RAYE DR STE C
Practice Address - Street 2:
Practice Address - City:DE QUEEN
Practice Address - State:AR
Practice Address - Zip Code:71832-4107
Practice Address - Country:US
Practice Address - Phone:866-282-0406
Practice Address - Fax:866-282-5926
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-76306-031363LA2200X, 363LG0600X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology