Provider Demographics
NPI:1508385576
Name:CLAY, STACIA
Entity Type:Individual
Prefix:
First Name:STACIA
Middle Name:
Last Name:CLAY
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 1:8210 BRENNEN DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70818-5751
Mailing Address - Country:US
Mailing Address - Phone:225-650-0740
Mailing Address - Fax:225-223-6617
Practice Address - Street 1:8210 BRENNEN DRIVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70818
Practice Address - Country:US
Practice Address - Phone:225-650-0740
Practice Address - Fax:225-223-6617
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver