Provider Demographics
NPI:1568050862
Name:CLAY, AMY ALLYN (CNP,DNP)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:ALLYN
Last Name:CLAY
Suffix:
Gender:F
Credentials:CNP,DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2601 S ELLIS RD
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-7067
Practice Address - Country:US
Practice Address - Phone:605-312-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-04
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR042462163WE0003X
SDCP001961363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No163WE0003XNursing Service ProvidersRegistered NurseEmergencyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDR042462OtherREGISTERED NURSE