Kandace Suzette McClellan, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA2016-0067 Issued in NM

Practice address

400 N Pennsylvania Ave Ste 920
Roswell, NM 88201-4779

Phone

(575) 208-2509

NPI assigned

Jun 24, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NM

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Roswell Skin Center, LLC

  • Family Medicine Physician
  • Roswell, NM
  • NPI 1447852488
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1466726400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646611200000",
    "number": "1760833388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 N PENNSYLVANIA AVE STE 920",
            "city": "ROSWELL",
            "state": "NM",
            "postal_code": "882014779",
            "telephone_number": "575-208-2509",
            "fax_number": "575-265-1700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 N PENNSYLVANIA AVE STE 920",
            "city": "ROSWELL",
            "state": "NM",
            "postal_code": "882014779",
            "telephone_number": "575-208-2509"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "350 W Country Club Rd",
            "address_2": "Suite #101",
            "address_purpose": "LOCATION",
            "city": "Roswell",
            "state": "NM",
            "postal_code": "882015205",
            "country_code": "US",
            "telephone_number": "575-624-5622",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "300 W Country Club Rd Ste 230",
            "address_purpose": "LOCATION",
            "city": "Roswell",
            "state": "NM",
            "postal_code": "882015240",
            "country_code": "US",
            "telephone_number": "575-622-1411",
            "fax_number": "575-624-5630",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "350 W Country Club Rd",
            "address_2": "Suite #101",
            "address_purpose": "LOCATION",
            "city": "Roswell",
            "state": "NM",
            "postal_code": "882015205",
            "country_code": "US",
            "telephone_number": "575-624-5622",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCCLELLAN",
        "first_name": "KANDACE",
        "middle_name": "SUZETTE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-24",
        "last_updated": "2022-03-07",
        "certification_date": "2022-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NM",
            "license": "PA2016-0067",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10601309",
            "state": "NM"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kandace.mcclellan.1@1610.direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "AMR Direct Address",
            "address_1": "300 W Country Club Rd Ste 230",
            "city": "Roswell",
            "state": "NM",
            "country_code": "US",
            "postal_code": "882015240",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Maurice W. Geldert OD PA
• Jennifer May, AGNP
• Kayelynn McBeth
• Joy Lane McClain, NBC-HWC
• Katherine McClain
• Susan Dee McClure, M.S., CCC-SLP
• Richard Allen McConnell, MPT
• Kevin McCormack, LBSW
• Alistair Peter McCrann, DPT, ATC
• Brian McDaid, D.O.M.

• Physician Assistant in Roswell, NM
• Providers in Roswell, NM by specialty
• Physician Assistant in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.