Provider Demographics
NPI:1669238846
Name:MCCLAIN, KEAUNA JOY
Entity type:Individual
Prefix:
First Name:KEAUNA
Middle Name:JOY
Last Name:MCCLAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 MIDWAY AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-1313
Mailing Address - Country:US
Mailing Address - Phone:937-759-7111
Mailing Address - Fax:
Practice Address - Street 1:4201 MIDWAY AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-1313
Practice Address - Country:US
Practice Address - Phone:937-759-7111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401495990313251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health