Provider Demographics
NPI:1972004349
Name:MCFADDEN, MARCELLETTE EDDILENE (APRN,FNPC,PMHNP)
Entity type:Individual
Prefix:
First Name:MARCELLETTE
Middle Name:EDDILENE
Last Name:MCFADDEN
Suffix:
Gender:F
Credentials:APRN,FNPC,PMHNP
Other - Prefix:
Other - First Name:EDIE
Other - Middle Name:
Other - Last Name:MCFADDEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN, FNPC, PMHNPBC
Mailing Address - Street 1:PO BOX 53607
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79453-3607
Mailing Address - Country:US
Mailing Address - Phone:806-438-1476
Mailing Address - Fax:
Practice Address - Street 1:726 E MICHIGAN DR STE 201
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-3467
Practice Address - Country:US
Practice Address - Phone:575-942-1970
Practice Address - Fax:806-209-0144
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-21
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135148363LF0000X, 363LP0808X
NM77378363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM77378OtherNM BON APRN LICENXSE
TXAP135148OtherTEXAS BNE APRN LICENSE