Healthcare Provider Details

I. General information

NPI: 1487450011
Provider Name (Legal Business Name): DENITA CLENDENIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2025
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 WALMART PLZ
SYLVA NC
28779-5808
US

IV. Provider business mailing address

241 BAYBERRY COVE RD
SYLVA NC
28779-9211
US

V. Phone/Fax

Practice location:
  • Phone: 828-631-9462
  • Fax:
Mailing address:
  • Phone: 321-506-1756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5022207
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: