Healthcare Provider Details

I. General information

NPI: 1245319250
Provider Name (Legal Business Name): CLINT P ROYSTON M.S., M.S.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 06/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 AURORA AVE STE 401E
URBANDALE IA
50322-2800
US

IV. Provider business mailing address

6200 AURORA AVE STE 401E
URBANDALE IA
50322-2800
US

V. Phone/Fax

Practice location:
  • Phone: 515-331-0303
  • Fax: 515-331-9086
Mailing address:
  • Phone: 515-331-0303
  • Fax: 515-331-9086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG-116306
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: