Provider Demographics
NPI:1659840486
Name:CLENDENEN, MAGGIE KING (AGPCNP-BC)
Entity Type:Individual
Prefix:MS
First Name:MAGGIE
Middle Name:KING
Last Name:CLENDENEN
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:MS
Other - First Name:MAGGIE
Other - Middle Name:KING
Other - Last Name:MANKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN/NP
Mailing Address - Street 1:THREE RIVERS CLINIC
Mailing Address - Street 2:158 HINTON BYPASS
Mailing Address - City:HINTON
Mailing Address - State:WV
Mailing Address - Zip Code:25951
Mailing Address - Country:US
Mailing Address - Phone:304-309-4143
Mailing Address - Fax:304-309-4146
Practice Address - Street 1:158 HINTON BYPASS
Practice Address - Street 2:THREE RIVERS CLINIC
Practice Address - City:HINTON
Practice Address - State:WV
Practice Address - Zip Code:25951
Practice Address - Country:US
Practice Address - Phone:304-309-4143
Practice Address - Fax:304-309-4146
Is Sole Proprietor?:No
Enumeration Date:2018-11-22
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN71119-AGPCNP-BC363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology