Provider Demographics
NPI:1104677558
Name:MCCLENDON, DEBBY (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:DEBBY
Middle Name:
Last Name:MCCLENDON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90220-1425
Mailing Address - Country:US
Mailing Address - Phone:310-635-7123
Mailing Address - Fax:310-635-0535
Practice Address - Street 1:201 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90220-1425
Practice Address - Country:US
Practice Address - Phone:310-635-7123
Practice Address - Fax:310-635-0535
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95028647363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity HealthGroup - Single Specialty