Provider Demographics
NPI:1295963692
Name:HUBBLE, CLAY J III (FNP-C)
Entity type:Individual
Prefix:
First Name:CLAY
Middle Name:J
Last Name:HUBBLE
Suffix:III
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:231 SAINT ANN DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-3219
Mailing Address - Country:US
Mailing Address - Phone:985-624-5410
Mailing Address - Fax:985-624-5490
Practice Address - Street 1:1616 S COLUMBIA ST
Practice Address - Street 2:STE. C
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-5880
Practice Address - Country:US
Practice Address - Phone:985-735-1685
Practice Address - Fax:985-735-1088
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2015-10-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LAAP05824363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily