Provider Demographics
NPI:1861925331
Name:MCCLAIN, KASEY LEIGH (APRN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:KASEY
Middle Name:LEIGH
Last Name:MCCLAIN
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4172 S JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-2028
Mailing Address - Country:US
Mailing Address - Phone:870-818-2666
Mailing Address - Fax:
Practice Address - Street 1:2280 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730
Practice Address - Country:US
Practice Address - Phone:870-444-5216
Practice Address - Fax:870-895-2164
Is Sole Proprietor?:No
Enumeration Date:2017-04-11
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005215363LF0000X, 363LF0000X
LARN151373163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR221076758Medicaid