Provider Demographics
NPI:1659459246
Name:MCCLENTON, THELMA JEAN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:THELMA
Middle Name:JEAN
Last Name:MCCLENTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7060 LONE OAK RD
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39773-8910
Mailing Address - Country:US
Mailing Address - Phone:662-494-7965
Mailing Address - Fax:662-320-4830
Practice Address - Street 1:1237 HIGHWAY 182 E
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-9529
Practice Address - Country:US
Practice Address - Phone:662-320-7001
Practice Address - Fax:662-320-4830
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR621714363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00118938Medicaid
MS00118938Medicaid
MSQ05462Medicare UPIN