Provider Demographics
NPI:1902982887
Name:MCCLINTON, SONIA L (FNP)
Entity type:Individual
Prefix:
First Name:SONIA
Middle Name:L
Last Name:MCCLINTON
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 1:5160 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39307-9145
Mailing Address - Country:US
Mailing Address - Phone:601-683-0279
Mailing Address - Fax:601-683-0366
Practice Address - Street 1:9421 EASTSIDE DRIVE EXTENTION
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MS
Practice Address - Zip Code:39345
Practice Address - Country:US
Practice Address - Phone:601-683-0279
Practice Address - Fax:601-683-0366
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR860101363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSR860101OtherMISS. BOARD OF NURSING
MS200600924022OtherAMERICAN NURSES CERTIFICA