Provider Demographics
NPI:1609807544
Name:CLAY, NANCY KATRINA (APRN)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:KATRINA
Last Name:CLAY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 TRACE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:DELBARTON
Mailing Address - State:WV
Mailing Address - Zip Code:25670-9689
Mailing Address - Country:US
Mailing Address - Phone:606-625-2332
Mailing Address - Fax:
Practice Address - Street 1:17379 EAST BIG CREEK ROAD
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:KY
Practice Address - Zip Code:41564-8574
Practice Address - Country:US
Practice Address - Phone:606-353-6926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV45912363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVPENDINGMedicaid
WVCANP12034Medicare PIN
WVPENDINGMedicaid