Provider Demographics
NPI:1336463660
Name:CLAY HUBBLE FNP LLC
Entity Type:Organization
Organization Name:CLAY HUBBLE FNP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLAY
Authorized Official - Middle Name:J
Authorized Official - Last Name:HUBBLE
Authorized Official - Suffix:III
Authorized Official - Credentials:FNP
Authorized Official - Phone:985-234-9450
Mailing Address - Street 1:69304 PREVOST RD
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-7702
Mailing Address - Country:US
Mailing Address - Phone:985-234-9450
Mailing Address - Fax:985-234-9450
Practice Address - Street 1:69304 PREVOST RD
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-7702
Practice Address - Country:US
Practice Address - Phone:985-234-9450
Practice Address - Fax:985-234-9450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05824363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty