1235616459 NPI number — NATALIE DAWN MCCLINTICK NP

Table of content: NATALIE DAWN MCCLINTICK NP (NPI 1235616459)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235616459 NPI number — NATALIE DAWN MCCLINTICK NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCLINTICK
Provider First Name:
NATALIE
Provider Middle Name:
DAWN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MROZ, PRATER, HOBBS, AND STEWART
Provider Other First Name:
NATALIE
Provider Other Middle Name:
DAWN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1235616459
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3600 W BETHEL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MUNCIE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47304-5407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-622-6575
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2610 ENTERPRISE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANDERSON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46013-9684
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-683-4400
Provider Business Practice Location Address Fax Number:
765-642-7903
Provider Enumeration Date:
07/20/2018

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: 363LF0000X , with the licence number:  71008142A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 71008142B . This is a "INDIANA CONTROLLED SUBSTANCE REGISTRATION" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: F0718507 . This is a "AMERICAN ACADEMY OF NURSE PRACTITIONER NATIONAL CERTIFICATION BOARD, INC." identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 28157223A . This is a "REGISTERED NURSE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 71008142A . This is a "ADVANCED NURSE PRACTITIONER" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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