Provider Demographics
NPI:1104310291
Name:MCCLAIN, KARLA RENE (CRNP)
Entity type:Individual
Prefix:
First Name:KARLA
Middle Name:RENE
Last Name:MCCLAIN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:KARLA
Other - Middle Name:RENE
Other - Last Name:PEDICONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4685 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-3397
Mailing Address - Country:US
Mailing Address - Phone:513-853-4721
Mailing Address - Fax:
Practice Address - Street 1:421 S CAMPUS AVE
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:OH
Practice Address - Zip Code:45056-2487
Practice Address - Country:US
Practice Address - Phone:513-529-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR222828363LP0808X
OHCNP022599363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health