Provider Demographics
NPI:1003843277
Name:CLAY, JO ANN (MSN, CNS, APN)
Entity Type:Individual
Prefix:MISS
First Name:JO ANN
Middle Name:
Last Name:CLAY
Suffix:
Gender:F
Credentials:MSN, CNS, APN
Other - Prefix:
Other - First Name:JO ANN
Other - Middle Name:
Other - Last Name:COLLIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, CNS, APN
Mailing Address - Street 1:680 HOGAN LN
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-8131
Mailing Address - Country:US
Mailing Address - Phone:501-505-8900
Mailing Address - Fax:501-505-8901
Practice Address - Street 1:680 HOGAN LN
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-8131
Practice Address - Country:US
Practice Address - Phone:501-505-8900
Practice Address - Fax:501-505-8901
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN 05 3165163WP0809X
ARB48862363LP0808X
AR501093 CNS364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
787856000OtherMAGELLAN
255804OtherCOMPSYCH
281471OtherUBH
5Y439Medicare ID - Type Unspecified