Provider Demographics
NPI:1457851198
Name:GARRETT MCCLELLAND, CONCYNTHIA ARNETT (LVN)
Entity Type:Individual
Prefix:
First Name:CONCYNTHIA
Middle Name:ARNETT
Last Name:GARRETT MCCLELLAND
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26739 FM 139
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75973-3751
Mailing Address - Country:US
Mailing Address - Phone:936-572-0216
Mailing Address - Fax:
Practice Address - Street 1:26739 FM 139
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TX
Practice Address - Zip Code:75973-3751
Practice Address - Country:US
Practice Address - Phone:936-572-0216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX226588164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse