Individual
CYNTHIA MCCLELLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
800 E DAWSON ST, TYLER, TX 75701-2036
(903) 525-1913
Mailing address
PO BOX 841656, DALLAS, TX 75284-1656
(903) 531-5000
Taxonomy
Speciality
Code
Description
License number
State
363LN0000X
Neonatal Nurse Practitioner
Primary
635040
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
198399103
—
TX
05
—
198399104
—
TX
01
—
8Y9301
BCBS
TX
01
—
TIN PLUS 042
TRICARE
TX
Enumeration date
11/21/2008
Last updated
11/13/2019
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