Provider Demographics
NPI:1891382479
Name:MCCLELLAN, SARAH KAILEEN (LVN)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:KAILEEN
Last Name:MCCLELLAN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4055 HOGAN DR APT 2707
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75709-6953
Mailing Address - Country:US
Mailing Address - Phone:903-283-6292
Mailing Address - Fax:
Practice Address - Street 1:4055 HOGAN DR APT 2707
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75709-6953
Practice Address - Country:US
Practice Address - Phone:903-283-6292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1021861164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse