Provider Demographics
NPI:1811436876
Name:CLAYTON, PATRICIA (PCP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:CLAYTON
Suffix:
Gender:F
Credentials:PCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 DALTON ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39204-2806
Mailing Address - Country:US
Mailing Address - Phone:601-941-1949
Mailing Address - Fax:
Practice Address - Street 1:1421 DALTON ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-2806
Practice Address - Country:US
Practice Address - Phone:601-941-1949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS81-5448170374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS81-5448170OtherIRS INDIVIDUAL TAXPAYER INDENTIFICATION NUMBER