Provider Demographics
NPI:1760884282
Name:MCCLENDON, PENELOPE (MSN, APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:PENELOPE
Middle Name:
Last Name:MCCLENDON
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 S CONROE MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-4722
Mailing Address - Country:US
Mailing Address - Phone:936-539-4004
Mailing Address - Fax:936-539-3635
Practice Address - Street 1:440 RAYFORD RD STE 150
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-4169
Practice Address - Country:US
Practice Address - Phone:936-539-4004
Practice Address - Fax:281-419-1395
Is Sole Proprietor?:No
Enumeration Date:2014-09-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAP126322363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4153132-01Medicaid
TX4153132-01Medicaid