Provider Demographics
NPI:1477348704
Name:MCCLELLAN, KEVIN (RVS, RCS)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:MCCLELLAN
Suffix:
Gender:
Credentials:RVS, RCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 377
Mailing Address - Street 2:
Mailing Address - City:ROYAL
Mailing Address - State:AR
Mailing Address - Zip Code:71968-0377
Mailing Address - Country:US
Mailing Address - Phone:501-276-6557
Mailing Address - Fax:
Practice Address - Street 1:307 GRISHAM RD
Practice Address - Street 2:
Practice Address - City:ROYAL
Practice Address - State:AR
Practice Address - Zip Code:71968-9565
Practice Address - Country:US
Practice Address - Phone:501-276-6557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR000662762471V0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular SonographyGroup - Single Specialty