Provider Demographics
NPI:1942770714
Name:CLENDENING, TIFFANY GAYLA (PMHNP)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:GAYLA
Last Name:CLENDENING
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 489
Mailing Address - Street 2:
Mailing Address - City:MT ENTERPRISE
Mailing Address - State:TX
Mailing Address - Zip Code:75681-0489
Mailing Address - Country:US
Mailing Address - Phone:903-392-8203
Mailing Address - Fax:866-835-6516
Practice Address - Street 1:410 N 4TH ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-6511
Practice Address - Country:US
Practice Address - Phone:903-234-8808
Practice Address - Fax:903-212-7899
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAP139914363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health