1477093391 NPI number — DR. PAULETTE MCCLAIN DNP, APRN, A-GNP-C

Table of content: REBEKAH LYNN GOFF CRNA (NPI 1821634981)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477093391 NPI number — DR. PAULETTE MCCLAIN DNP, APRN, A-GNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCLAIN
Provider First Name:
PAULETTE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DNP, APRN, A-GNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477093391
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/16/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
01/21/2021
NPI Reactivation Date:
02/10/2021

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8786 GOODWOOD BLVD STE 107
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70806-7917
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-229-6356
Provider Business Mailing Address Fax Number:
833-913-2021

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
761 COLONIAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70806-6512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-305-7406
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/24/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP2300X , with the licence number:  AP09212 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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