Provider Demographics
NPI:1588123194
Name:MCCLENDON, MARGARET JEAN (PA)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:JEAN
Last Name:MCCLENDON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MEG
Other - Middle Name:
Other - Last Name:MCCLENDON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:105 CARRIAGE DR
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-6502
Mailing Address - Country:US
Mailing Address - Phone:972-935-3258
Mailing Address - Fax:
Practice Address - Street 1:1441 S MIDLOTHIAN PKWY STE 100A
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-5597
Practice Address - Country:US
Practice Address - Phone:469-800-9440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-14
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA12575363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA12575OtherTEXAS MEDICAL BOARD