Provider Demographics
NPI:1609507086
Name:MCCLENDON, CHIQUITA
Entity type:Individual
Prefix:
First Name:CHIQUITA
Middle Name:
Last Name:MCCLENDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 W MCCLENDON LN
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:MS
Mailing Address - Zip Code:39074-7745
Mailing Address - Country:US
Mailing Address - Phone:601-900-8524
Mailing Address - Fax:
Practice Address - Street 1:108 COURT SQ
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MS
Practice Address - Zip Code:39051-4114
Practice Address - Country:US
Practice Address - Phone:601-900-8524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program