Provider Demographics
NPI:1336171172
Name:MASTERS, CLAY WESLEY (ARNP)
Entity Type:Individual
Prefix:MR
First Name:CLAY
Middle Name:WESLEY
Last Name:MASTERS
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 E 19TH ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4707
Mailing Address - Country:US
Mailing Address - Phone:850-763-5409
Mailing Address - Fax:850-763-4072
Practice Address - Street 1:204 E 19TH ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4707
Practice Address - Country:US
Practice Address - Phone:850-763-5409
Practice Address - Fax:850-763-4072
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9168146363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL307144800Medicaid