Provider Demographics
NPI:1093082661
Name:CLAYTON, MELISA ANN (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:MELISA
Middle Name:ANN
Last Name:CLAYTON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 E CALLE CINCO VECINOS
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-6928
Mailing Address - Country:US
Mailing Address - Phone:520-471-3479
Mailing Address - Fax:
Practice Address - Street 1:41 E CALLE CINCO VECINOS
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-6928
Practice Address - Country:US
Practice Address - Phone:520-471-3479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-25
Last Update Date:2011-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4204363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care