Mcclellan, Kandace Suzette
Mcclellan, Kandace Suzette is an individual health care provider with primary practice located at 400 N Pennsylvania Ave Ste 920 , Roswell NM 88201-4779. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Mcclellan, Kandace Suzette can be contacted via phone (575) 208-2509.Contact Information
Primary practice address
400 N Pennsylvania Ave Ste 920
Roswell NM 88201-4779
Phone: (575) 208-2509
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | ||
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | PA2016-0067 | New Mexico |
Profile Details
| NPI number | 1760833388 |
|---|---|
| LBN Legal business name | Mcclellan, Kandace Suzette |
| Credentials | Physician's Assistant Certified (PA-C) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 24th, 2016 |
| Last updated | Mar 7th, 2022 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1760833388 | NPPES |
| New Mexico | MEDICAID | 10601309 |
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