Provider Demographics
NPI:1134909245
Name:MCCLAIN, BRIELLE (LPN)
Entity type:Individual
Prefix:
First Name:BRIELLE
Middle Name:
Last Name:MCCLAIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:BRIELLE
Other - Middle Name:
Other - Last Name:CAVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:355 SUN PRAIRIE ST
Mailing Address - Street 2:
Mailing Address - City:PRYOR
Mailing Address - State:OK
Mailing Address - Zip Code:74361-7839
Mailing Address - Country:US
Mailing Address - Phone:918-813-1794
Mailing Address - Fax:
Practice Address - Street 1:355 SUN PRAIRIE ST
Practice Address - Street 2:
Practice Address - City:PRYOR
Practice Address - State:OK
Practice Address - Zip Code:74361-7839
Practice Address - Country:US
Practice Address - Phone:918-813-1794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKL0069459164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse