Individual
TISHA MCCLELLAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1450 AIRPORT RD, BRANSON, MO 65616-7207
(417) 559-9860
Mailing address
1450 AIRPORT RD, BRANSON, MO 65616-7207
(417) 559-9860
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
J071099002
MO
Other
Enumeration date
02/13/2023
Last updated
02/13/2023
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