Provider Demographics
NPI:1508166281
Name:CLAYTON, LACY RAE (RN, NP, DNP)
Entity Type:Individual
Prefix:MS
First Name:LACY
Middle Name:RAE
Last Name:CLAYTON
Suffix:
Gender:F
Credentials:RN, NP, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 WAVERLY RD
Mailing Address - Street 2:
Mailing Address - City:WYNCOTE
Mailing Address - State:PA
Mailing Address - Zip Code:19095-1322
Mailing Address - Country:US
Mailing Address - Phone:267-944-6220
Mailing Address - Fax:
Practice Address - Street 1:102 WAVERLY RD
Practice Address - Street 2:
Practice Address - City:WYNCOTE
Practice Address - State:PA
Practice Address - Zip Code:19095-1322
Practice Address - Country:US
Practice Address - Phone:267-944-6220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-27
Last Update Date:2023-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP015382363LP0808X
MARN2269120363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health