Provider Demographics
NPI:1780411652
Name:MCCLENDON, TABREYEA
Entity type:Individual
Prefix:
First Name:TABREYEA
Middle Name:
Last Name:MCCLENDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2346 S LYNHURST DR STE 304
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46241-5171
Mailing Address - Country:US
Mailing Address - Phone:317-737-9029
Mailing Address - Fax:
Practice Address - Street 1:2346 S LYNHURST DR STE 304
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-5171
Practice Address - Country:US
Practice Address - Phone:317-737-9029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INCNA2004044376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide