Provider Demographics
NPI:1134357445
Name:MCCLINTOCK GLOVER, JESSICA YVONNE (MD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:YVONNE
Last Name:MCCLINTOCK GLOVER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:LOGANSPORT
Mailing Address - State:IN
Mailing Address - Zip Code:46947-1593
Mailing Address - Country:US
Mailing Address - Phone:574-722-3566
Mailing Address - Fax:
Practice Address - Street 1:1025 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:LOGANSPORT
Practice Address - State:IN
Practice Address - Zip Code:46947-1593
Practice Address - Country:US
Practice Address - Phone:574-722-3566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01073034A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000830960OtherANTHEM
IN201178870Medicaid
IN000000830960OtherANTHEM