Provider Demographics
NPI:1013999416
Name:CLAYTON, HELEN K (RN, PNP)
Entity Type:Individual
Prefix:
First Name:HELEN
Middle Name:K
Last Name:CLAYTON
Suffix:
Gender:F
Credentials:RN, PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 RAWLS DR SUITE 100
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648
Mailing Address - Country:US
Mailing Address - Phone:601-684-7623
Mailing Address - Fax:601-684-7247
Practice Address - Street 1:300 RAWLS DR SUITE 100
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648
Practice Address - Country:US
Practice Address - Phone:601-684-7623
Practice Address - Fax:601-684-7247
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR120320208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00120031Medicaid