Provider Demographics
NPI:1336404052
Name:MCCLAIN, TONYA (PNP)
Entity Type:Individual
Prefix:MS
First Name:TONYA
Middle Name:
Last Name:MCCLAIN
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 N ONE MILE RD
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MO
Mailing Address - Zip Code:63841-2539
Mailing Address - Country:US
Mailing Address - Phone:573-624-3600
Mailing Address - Fax:
Practice Address - Street 1:610 N ONE MILE RD
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MO
Practice Address - Zip Code:63841-2539
Practice Address - Country:US
Practice Address - Phone:573-624-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO123970363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics