Active NPI
Shawanna Latricia McClendon, FNP-BC
- Family Medicine Physician
- Jackson, MS
National Provider Identifier
1285509018
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 907824
- Practice address
- 153 Blackmon Rd
Jackson, MS 39272-6002 - Phone
- (601) 665-3034
- NPI assigned
- Oct 9, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 907824 | MS | Primary |
Addresses
Primary practice location
153 Blackmon Rd
Jackson, MS 39272-6002
Mailing address
153 Blackmon Rd
Jackson, MS 39272-6002
Phone (601) 665-3034
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 907824 | MS | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1759968000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1762214400000",
"number": "1285509018",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "153 BLACKMON RD",
"city": "JACKSON",
"state": "MS",
"postal_code": "392726002",
"telephone_number": "601-665-3034"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "153 BLACKMON RD",
"city": "JACKSON",
"state": "MS",
"postal_code": "392726002",
"telephone_number": "601-665-3034"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCLENDON",
"first_name": "SHAWANNA",
"middle_name": "LATRICIA",
"credential": "FNP-BC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-10-09",
"last_updated": "2025-11-04",
"certification_date": "2025-11-04",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MS",
"license": "907824",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jackson, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.