Provider Demographics
NPI:1447736517
Name:MCCLENDON, SHONTAI (LVN)
Entity Type:Individual
Prefix:
First Name:SHONTAI
Middle Name:
Last Name:MCCLENDON
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3803 SHELLROCK DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-7620
Mailing Address - Country:US
Mailing Address - Phone:254-813-3388
Mailing Address - Fax:
Practice Address - Street 1:3803 SHELLROCK DR
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-7620
Practice Address - Country:US
Practice Address - Phone:254-813-3388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX308329164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse