Provider Demographics
NPI:1881670933
Name:CLAY, ADELE I (APRN)
Entity Type:Individual
Prefix:MS
First Name:ADELE
Middle Name:I
Last Name:CLAY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:ADELE
Other - Middle Name:L
Other - Last Name:ISKRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:2110 SILAS DEANE HWY
Mailing Address - Street 2:STARLING PHYSICIANS
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-2313
Mailing Address - Country:US
Mailing Address - Phone:860-258-3470
Mailing Address - Fax:860-571-6800
Practice Address - Street 1:375 WILLARD AVE
Practice Address - Street 2:STARLING PHYSICIANS
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-2300
Practice Address - Country:US
Practice Address - Phone:860-666-5111
Practice Address - Fax:860-826-4957
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003229363LA2200X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004221959Medicaid
CT370018OtherWELLCARE MEDICARE
CT2V7383OtherHEALTH NET
CT322900OtherCONNECTICARE
CT400003229CT02OtherBCBS NEWINGTON LOCATION
CT1255448155OtherGHMC GROUP NPI
CT004224846OtherMEDICAID GROUP PROVIDER N
CT400003229CT01OtherBCBS PLAINVILLE LOCATION
CTP3654104OtherOXFORD
CT004224846OtherMEDICAID GROUP PROVIDER N
CT1255448155OtherGHMC GROUP NPI
CT500001534Medicare ID - Type Unspecified