Provider Demographics
NPI:1316966617
Name:MCCLELLAN, PATRICIA DARLENE (PA-C)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:DARLENE
Last Name:MCCLELLAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 98978
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-8978
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:3960 W CRAIG RD
Practice Address - Street 2:SUITE 101
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-2731
Practice Address - Country:US
Practice Address - Phone:702-473-8380
Practice Address - Fax:702-473-8383
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA-C48363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1316966617Medicaid
NVVDM052ZMedicare PIN