Basic Information
| Provider Information | |||||||||
| NPI: | 1831862093 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCLUSKEY | ||||||||
| FirstName: | SALLY | ||||||||
| MiddleName: | DEE | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 112 COUNTY ROAD 138 | ||||||||
| Address2: | |||||||||
| City: | SWEETWATER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 795566140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3253380475 | ||||||||
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| Practice Location | |||||||||
| Address1: | 201 E ARIZONA AVE | ||||||||
| Address2: | |||||||||
| City: | SWEETWATER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 795567119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3252358641 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2021 | ||||||||
| LastUpdateDate: | 07/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 1034328 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.