Provider Demographics
NPI:1083481022
Name:CLAY-MCCARTY, KARENA
Entity Type:Individual
Prefix:
First Name:KARENA
Middle Name:
Last Name:CLAY-MCCARTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 N LAMB BLVD SPC 120
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-1348
Mailing Address - Country:US
Mailing Address - Phone:310-923-4641
Mailing Address - Fax:
Practice Address - Street 1:4423 W FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-3703
Practice Address - Country:US
Practice Address - Phone:702-458-1137
Practice Address - Fax:702-458-1423
Is Sole Proprietor?:No
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLPN16959164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse