Individual
LISSA NGUYEN MCCLENDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
515 W MAYFIELD RD STE 102, ARLINGTON, TX 76014-2084
(817) 759-7000
(817) 759-7027
Mailing address
800 W MAGNOLIA AVE, FORT WORTH, TX 76104-4611
(817) 759-7000
(817) 759-7027
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA16783
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA16783
STATE LICENSE
TX
Enumeration date
03/07/2023
Last updated
02/10/2025
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