Provider Demographics
NPI:1760679179
Name:MCCLENDON, ANNETTE ANN (ARNP)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:ANN
Last Name:MCCLENDON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MRS
Other - First Name:ANNETTE
Other - Middle Name:ANN
Other - Last Name:MCCLENDON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:1030 N CENTER PKWY STE 316
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7160
Mailing Address - Country:US
Mailing Address - Phone:509-735-5052
Mailing Address - Fax:509-222-2223
Practice Address - Street 1:1030 N CENTER PKWY STE 316
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7160
Practice Address - Country:US
Practice Address - Phone:509-735-5052
Practice Address - Fax:509-222-2223
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-29
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007893363LP0808X, 363L00000X, 363LF0000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1760679179OtherPREMERA
WA176069179Medicaid