Provider Demographics
NPI:1407401789
Name:CLAY, SANDRA LYNN (FNP-C)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LYNN
Last Name:CLAY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 1/2 MAPLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-6113
Mailing Address - Country:US
Mailing Address - Phone:304-894-6693
Mailing Address - Fax:
Practice Address - Street 1:300 CARRIAGE DR
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-2812
Practice Address - Country:US
Practice Address - Phone:304-255-7878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV104153363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily