Provider Demographics
NPI:1942464342
Name:MCLEAN, JILL ELYSE (FNP-C)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:ELYSE
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W HALSELL ST
Mailing Address - Street 2:
Mailing Address - City:DIMMITT
Mailing Address - State:TX
Mailing Address - Zip Code:79027-1846
Mailing Address - Country:US
Mailing Address - Phone:806-647-2194
Mailing Address - Fax:806-647-3769
Practice Address - Street 1:300 W HALSELL ST
Practice Address - Street 2:
Practice Address - City:DIMMITT
Practice Address - State:TX
Practice Address - Zip Code:79027
Practice Address - Country:US
Practice Address - Phone:806-647-2194
Practice Address - Fax:806-647-3769
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX555115363LF0000X
TXAP109982363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX063566601Medicaid
TX063566602Medicaid
TX00N49AOtherBCBS
TX458679OtherMEDICARE
TX00N49AOtherMEDICARE PART B
TX084207201Medicaid
TX458679OtherMEDICARE