KANDACE SUZETTE MCCLELLAN (NPI# 1760833388) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760833388 |
| Entity Type | Individual |
| Full Name | KANDACE SUZETTE MCCLELLAN |
| Credential | PA-C |
| Practice Address |
300 W Country Club Rd Ste 230 Roswell NM 88201-5240 |
| Practice Telephone | 5756221411 |
| Practice Fax Number | 5756245630 |
| Mailing Telephone | 5756221411 |
| Mailing Fax Number | 5756245630 |
| Enumeration Date | 2016-06-24 |
| Last Update Date | 2020-09-15 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA2016-0067 | NM | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NM | 10601309 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 350 W Country Club Rd, Suite #101, Roswell, NM 882015205 | 5756245622 |
| Street Address |
300 W COUNTRY CLUB RD STE 230 |
| City | ROSWELL |
| State | NM |
| Zip Code | 88201-5240 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265437305 | Richard Pinon Jr. | Family Medicine | 300 W Country Club Rd Ste 230, Roswell, NM 88201-5240 | 2005-06-16 |
| 1598283145 | Megan Leigh Brandt | Nurse Practitioner | 300 W Country Club Rd Ste 230, Roswell, NM 88201-5240 | 2017-09-05 |
| 1104356963 | Kim Hestand | Nurse Practitioner | 300 W Country Club Rd Ste 230, Roswell, NM 88201-5240 | 2017-06-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902310022 | Corey A Carter | Specialist/Technologist, Other | 117 E 19th Street, Roswell, NM 88201 | 2017-11-28 |
| 1326598541 | Dove Medical Corporation | Family Medicine | 110 East 3rd Street, Roswell, NM 88201 | 2016-10-12 |
| 1841748381 | Anali Velez | Registered Nurse | 300 N Kentucky, Roswell, NM 88201 | 2016-09-13 |
| 1831647379 | Rebecca Palomino | Registered Nurse | 800 Marion Richards Rd, Roswell, NM 88201 | 2016-09-13 |
| 1215300926 | Heart Path Oriental Medicine | Clinic/Center | 810 N Union, Roswell, NM 88201 | 2015-11-03 |
| 1538564745 | Lacey Scott | Pharmacist | 1835 N. Main, Roswell, NM 88201 | 2014-10-30 |
| 1962815852 | Marium Khan | Internal Medicine | 400 Military Heights Place, Roswell, NM 88201 | 2014-06-09 |
| 1316288913 | Anaya Counseling | Community/Behavioral Health | 613 W 2nd St Ste 4, Roswell, NM 88201 | 2013-03-06 |
| 1205185386 | Rosarita Brady | Occupational Therapist | 300 N. Kentucky, Roswell, NM 88201 | 2012-09-05 |
| 1922360049 | Ashley Spinhirne Thompson | Speech-Language Pathologist | 304 N. Richardson, Roswell, NM 88201 | 2012-06-14 |
| Find all providers in zip 88201 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790232031 | Christina Danielle Dicioccio | Physician Assistant | 11040 Crabapple Rd # Suiea, Roswell, GA 30075 | 2016-09-02 |
| 1598934481 | Andrew Neil Wasserberg | Physician Assistant | 400 N. Pennsylvania Ave, Suite 101, Roswell, NM 88201 | 2008-02-25 |
| 1073572954 | Thomas Alan Geckler | Physician Assistant | 500 Sun Valley Dr, Suite A-2, Roswell, GA 30076-1482 | 2006-03-21 |
| 1861481335 | Anna Marie Bauer | Physician Assistant | 1289 Hembree Rd, Suite 200-a, Roswell, GA 30076 | 2005-10-18 |
| 1841287471 | Carrie Flury | Physician Assistant | 712 W Hobbs St, Roswell, NM 88203-3646 | 2005-09-29 |
| 1538674650 | Carla Perry-davis | Physician Assistant | 1357 Hembree Rd Ste 200, Roswell, GA 30076-5710 | 2017-12-12 |
| 1114445590 | Mark Amba Standley | Physician Assistant | 111 W Hobbs St, Roswell, NM 88203-1869 | 2017-09-06 |
| 1801203666 | Kimberly Ann Donahue | Physician Assistant | 1825 Old Alabama Rd, Suite 201, Roswell, GA 30076-2273 | 2014-07-14 |
| 1205267432 | Norman Bowers | Physician Assistant | 303 W Country Club Rd, Roswell, NM 88201-5892 | 2013-12-13 |
| 1932539293 | Kingel N Desai | Physician Assistant | 1340 Upper Hembree Rd Ste A, Roswell, GA 30076 | 2013-11-22 |
| Find all providers in ROSWELL | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.