MEDICARE: ANNETTE ANN MCCLENDON ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP30007893	WA
2	363L00000X	Nurse Practitioner	AP30007893	WA
3	363LF0000X	Family Nurse Practitioner	AP30007893	WA
4	363LP0200X	Pediatric Nurse Practitioner	AP30007893	WA

General Provider Information

NPI Number	:	1760679179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNETTE ANN MCCLENDON ARNP

Provider Business Mailing Address
First Line	:	1030 N CENTER PKWY STE 316
Second Line	:
City	:	KENNEWICK
State	:	WA
Zip	:	99336-7160
Country	:	US
Telephone Number	:	509-735-5052
Fax Number	:	509-222-2223

Provider Business Practice Location Address
First Line	:	1030 N CENTER PKWY STE 316
Second Line	:
City	:	KENNEWICK
State	:	WA
Zip	:	99336-7160
Country	:	US
Telephone Number	:	509-735-5052
Fax Number	:	509-222-2223

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2007
Last Update Date	:	07/31/2023

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