Healthcare Provider Details

I. General information

NPI: 1194201277
Provider Name (Legal Business Name): CLAY SHEFFIELD AGEE FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2018
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 AIRPORT BLVD STE A101
MOBILE AL
36608-6767
US

IV. Provider business mailing address

6701 AIRPORT BLVD STE D143
MOBILE AL
36608-6701
US

V. Phone/Fax

Practice location:
  • Phone: 251-660-3515
  • Fax: 251-660-3516
Mailing address:
  • Phone: 251-342-3949
  • Fax: 251-266-3361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number904674
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3-000004
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-185604
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number24450
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: