Provider Demographics
NPI:1417792037
Name:MCCALLUM, GRETCHEN (APRN)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:MCCALLUM
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 SUNSHINE ACRES TRL
Mailing Address - Street 2:
Mailing Address - City:ROYAL
Mailing Address - State:AR
Mailing Address - Zip Code:71968-9791
Mailing Address - Country:US
Mailing Address - Phone:501-248-3134
Mailing Address - Fax:
Practice Address - Street 1:2 SAINT VINCENT CIR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5499
Practice Address - Country:US
Practice Address - Phone:501-248-3134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR229359363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care