Individual
JESSICA ANNE MCLENDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
979 E 3RD ST, SUITE C430, CHATTANOOGA, TN 37403-2136
(423) 778-4900
(423) 778-4901
Mailing address
975 E 3RD ST, ATTN: PROVIDER ENROLLMENT, CHATTANOOGA, TN 37403-2147
(423) 778-5630
(423) 778-3146
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2801
TN
363AM0700X
Medical Physician Assistant
005734
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005734
GA STATE LICENSE
GA
01
—
1089225
NCCPA IDENTIFICATION NUMBER
—
01
—
2801
TENNESSEE STATE LICENSE
TN
05
—
Q014360
—
TN
Enumeration date
11/23/2009
Last updated
09/29/2015
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