Provider Demographics
NPI:1629493515
Name:CLAYTOR, KATHRYN HEAD (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:HEAD
Last Name:CLAYTOR
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4414 WALFORDE BLVD
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-1401
Mailing Address - Country:US
Mailing Address - Phone:770-827-5723
Mailing Address - Fax:
Practice Address - Street 1:40 FOX CHASE
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120
Practice Address - Country:US
Practice Address - Phone:770-382-0185
Practice Address - Fax:770-382-0247
Is Sole Proprietor?:No
Enumeration Date:2014-02-28
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN200233363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily