Provider Demographics
NPI:1962098384
Name:MCCLENDON, COURTNEY HEATHER (APRN)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:HEATHER
Last Name:MCCLENDON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:YATES CENTER
Mailing Address - State:KS
Mailing Address - Zip Code:66783-1444
Mailing Address - Country:US
Mailing Address - Phone:620-625-2746
Mailing Address - Fax:
Practice Address - Street 1:204 S MAIN ST
Practice Address - Street 2:
Practice Address - City:YATES CENTER
Practice Address - State:KS
Practice Address - Zip Code:66783-1444
Practice Address - Country:US
Practice Address - Phone:620-625-2746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-19
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-79864-101363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty