Provider Demographics
NPI:1518555333
Name:SIBLEY, CLAYTON (ATC, LAT)
Entity type:Individual
Prefix:
First Name:CLAYTON
Middle Name:
Last Name:SIBLEY
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 SULLIVANT RD
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38606-9548
Mailing Address - Country:US
Mailing Address - Phone:166-293-4425
Mailing Address - Fax:
Practice Address - Street 1:287 MS-6
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606
Practice Address - Country:US
Practice Address - Phone:662-578-7799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSAT-08692255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2000028584OtherBOARD OF CERTIFICATION FOR THE ATHLETIC TRAINER
MSAT-0869OtherMISSISSIPPI LICENSE FOR ATHLETIC TRAINING