Provider Demographics
NPI:1982895363
Name:MCCALL, TINA LEE (NP)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:LEE
Last Name:MCCALL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:LEE
Other - Last Name:BARGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:111 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:TN
Mailing Address - Zip Code:38340-2313
Mailing Address - Country:US
Mailing Address - Phone:731-989-2829
Mailing Address - Fax:731-520-0232
Practice Address - Street 1:402 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-2900
Practice Address - Country:US
Practice Address - Phone:731-935-9472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12769363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily