MEDICARE: HATTIE DENICE CLAYTON PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	2018082894	NC

General Provider Information

NPI Number	:	1396209250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HATTIE DENICE CLAYTON PMHNP

Provider Business Mailing Address
First Line	:	90 SOUTHSIDE AVE STE 350
Second Line	:
City	:	ASHEVILLE
State	:	NC
Zip	:	28801-4184
Country	:	US
Telephone Number	:	828-210-2042
Fax Number	:	828-240-2043

Provider Business Practice Location Address
First Line	:	2931 BREEZEWOOD AVE STE 104
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28303-5281
Country	:	US
Telephone Number	:	910-491-1134
Fax Number	:	910-491-1332

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2019
Last Update Date	:	05/18/2026

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