1689230237 NPI number — ALLISON CECILIA CLAY FNP

Table of content: ALLISON CECILIA CLAY FNP (NPI 1689230237)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689230237 NPI number — ALLISON CECILIA CLAY FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLAY
Provider First Name:
ALLISON
Provider Middle Name:
CECILIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689230237
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 896199
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28289-6199
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
833-936-1364
Provider Business Mailing Address Fax Number:
605-942-7505

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1668 NC HIGHWAY 16 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAYLORSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28681-6285
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-632-9736
Provider Business Practice Location Address Fax Number:
828-632-9544
Provider Enumeration Date:
05/18/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  F01190970 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: WD02M8 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)