Provider Demographics
NPI:1912088634
Name:MCCLELLAND, ALYSSA C (FNP)
Entity Type:Individual
Prefix:MS
First Name:ALYSSA
Middle Name:C
Last Name:MCCLELLAND
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1920 2ND LOOP RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-6123
Mailing Address - Country:US
Mailing Address - Phone:843-678-9777
Mailing Address - Fax:843-665-2814
Practice Address - Street 1:40 OKATIE CENTER BLVD S
Practice Address - Street 2:SUITE 350
Practice Address - City:OKATIE
Practice Address - State:SC
Practice Address - Zip Code:29909-7507
Practice Address - Country:US
Practice Address - Phone:843-705-3800
Practice Address - Fax:843-705-3840
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3032363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP1082Medicaid
SC3032OtherLICENSE
SCNP1082Medicaid