Provider Demographics
NPI:1447619259
Name:CLENDENIN, KIMELIA (ARNP)
Entity Type:Individual
Prefix:
First Name:KIMELIA
Middle Name:
Last Name:CLENDENIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9601 PROSPECT DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-5926
Mailing Address - Country:US
Mailing Address - Phone:386-235-7301
Mailing Address - Fax:
Practice Address - Street 1:701 E TUDOR RD STE 120
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-7456
Practice Address - Country:US
Practice Address - Phone:907-264-1370
Practice Address - Fax:907-787-2207
Is Sole Proprietor?:No
Enumeration Date:2016-02-22
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1557042363LG0600X
AK121432363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology