Provider Demographics
NPI:1265254189
Name:MCCLINTON, BRIANA
Entity type:Individual
Prefix:
First Name:BRIANA
Middle Name:
Last Name:MCCLINTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 BUTTERFIELD COACH RD APT M101
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-0339
Mailing Address - Country:US
Mailing Address - Phone:901-515-7479
Mailing Address - Fax:
Practice Address - Street 1:514 BUTTERFIELD COACH RD APT M101
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-0339
Practice Address - Country:US
Practice Address - Phone:901-515-7479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR017798801272376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide