Provider Demographics
NPI:1568092179
Name:CLAY, KENNETH LANE
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:LANE
Last Name:CLAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ASMA BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3868
Mailing Address - Country:US
Mailing Address - Phone:337-456-7880
Mailing Address - Fax:
Practice Address - Street 1:100 ASMA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3868
Practice Address - Country:US
Practice Address - Phone:337-319-1948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator