Provider Demographics
NPI:1982608758
Name:CLEVER, WILLIAM (FNP)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:CLEVER
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 E MAIN ST STE 2E
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-5749
Mailing Address - Country:US
Mailing Address - Phone:423-282-2516
Mailing Address - Fax:423-282-3743
Practice Address - Street 1:207 E MAIN ST STE 2E
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-5749
Practice Address - Country:US
Practice Address - Phone:423-282-2516
Practice Address - Fax:423-282-3743
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN 8014363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4135121OtherBLUE CARE
TN203807201OtherTAX ID
TN3642412Medicaid
TN4135121OtherBCBS OF TN
TN203807201OtherTAX ID
P67421Medicare UPIN