Healthcare Provider Details

I. General information

NPI: 1518590561
Provider Name (Legal Business Name): SHELLEY CLAYTON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2020
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8860 ZIONSVILLE RD STE C
INDIANAPOLIS IN
46268-1061
US

IV. Provider business mailing address

8860 ZIONSVILLE RD STE C
INDIANAPOLIS IN
46268-1061
US

V. Phone/Fax

Practice location:
  • Phone: 317-855-9100
  • Fax:
Mailing address:
  • Phone: 317-855-9100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28198217A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number28198217A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: