Provider Demographics
NPI:1790303816
Name:CLAYTON, COMANECHI (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:COMANECHI
Middle Name:
Last Name:CLAYTON
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 HIGHWAY 39 N STE K
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-2725
Mailing Address - Country:US
Mailing Address - Phone:601-627-0257
Mailing Address - Fax:601-258-4682
Practice Address - Street 1:1821 HIGHWAY 39 N STE K
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-2725
Practice Address - Country:US
Practice Address - Phone:601-627-0257
Practice Address - Fax:601-258-4682
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-160325363LP0808X
MS903953363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1-160325OtherLICENSE