Basic Information
| Provider Information | |||||||||
| NPI: | 1568929487 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCCLURE | ||||||||
| FirstName: | KATLYN | ||||||||
| MiddleName: | REINE | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4261 STOCKTON DRIVE SUITE LL100 | ||||||||
| Address2: | |||||||||
| City: | NORTH LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5019757456 | ||||||||
| FaxNumber: | 5019781822 | ||||||||
| Practice Location | |||||||||
| Address1: | 9601 BAPTIST HEALTH DR STE 860 | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722056375 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5019757455 | ||||||||
| FaxNumber: | 5019753631 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2019 | ||||||||
| LastUpdateDate: | 06/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA-826 | AR | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.