Susan Kathryn McClintock, APRN

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

53-76306-031 Issued in KS

Practice address

405 E Collin Raye Dr Ste C
De Queen, AR 71832-4107

Phone

(866) 282-0406

Fax

(866) 282-5926

NPI assigned

Apr 2, 2014

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Interoperability endpoints

• Direct secure messaging: mcclintock@pcl-tx.direct.office.nextgen.com

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1396396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1558310400000",
    "number": "1891113262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 E COLLIN RAYE DR STE C",
            "city": "DE QUEEN",
            "state": "AR",
            "postal_code": "718324107",
            "telephone_number": "866-282-0406",
            "fax_number": "866-282-5926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 E COLLIN RAYE DR STE C",
            "city": "DE QUEEN",
            "state": "AR",
            "postal_code": "718324107",
            "telephone_number": "866-282-0406",
            "fax_number": "866-282-5926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCLINTOCK",
        "first_name": "SUSAN",
        "middle_name": "KATHRYN",
        "name_prefix": "Miss",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-04-02",
        "last_updated": "2019-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "KS",
            "license": "53-76306-031",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "KS",
            "license": "53-76306-031",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "KS",
            "license": "53-76306-031",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bonita Lois Martin, NP
• Kimberly Ann Martin, MS, OTR/L
• Marlen Martinez
• Suguey Martinez, RDH
• Nickolas Matthews, APRN-CNP
• McCurtain Memorial Medical Management, Inc.
• Med Southwest, PLLC
• Jessica Mendez
• Mitchell Medical
• Daryl Boyd Mitchell, LCSW

• Nurse Practitioner in De Queen, AR
• Providers in De Queen, AR by specialty
• Nurse Practitioner in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.