Individual
KANDACE SUZETTE MCCLELLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
400 N PENNSYLVANIA AVE STE 920, ROSWELL, NM 88201-4779
(575) 208-2509
Mailing address
400 N PENNSYLVANIA AVE STE 920, ROSWELL, NM 88201-4779
(575) 208-2509
(575) 265-1700
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2016-0067
NM
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10601309
—
NM
Enumeration date
06/24/2016
Last updated
03/07/2022
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