Provider Demographics
NPI:1255943296
Name:MCLENDON, DOMINICA J (NP)
Entity type:Individual
Prefix:
First Name:DOMINICA
Middle Name:J
Last Name:MCLENDON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 NORTH MAIN, SECOND FLOOR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205-1204
Mailing Address - Country:US
Mailing Address - Phone:210-237-4492
Mailing Address - Fax:210-828-0590
Practice Address - Street 1:610 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-1204
Practice Address - Country:US
Practice Address - Phone:210-225-6508
Practice Address - Fax:210-225-1486
Is Sole Proprietor?:No
Enumeration Date:2020-08-20
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX796155163W00000X
TX1007398363LF0000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily