Provider Demographics
NPI:1487499471
Name:MCCLAIN, KATIE LLEWELLYN KERR (FNP)
Entity type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:LLEWELLYN KERR
Last Name:MCCLAIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 MANLEY RD
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:AL
Mailing Address - Zip Code:35592-4947
Mailing Address - Country:US
Mailing Address - Phone:205-712-3121
Mailing Address - Fax:
Practice Address - Street 1:830 S GLOSTER ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4934
Practice Address - Country:US
Practice Address - Phone:662-377-4161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2024-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS906898363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner