Healthcare Provider Details

I. General information

NPI: 1356313365
Provider Name (Legal Business Name): ROBERT W CLAYTON III CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 AIMEE RD
FERRIDAY LA
71334-9615
US

IV. Provider business mailing address

241 AIMEE RD
FERRIDAY LA
71334-9615
US

V. Phone/Fax

Practice location:
  • Phone: 318-336-2220
  • Fax: 318-336-6060
Mailing address:
  • Phone: 318-336-2220
  • Fax: 318-336-6060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN029650AP02167
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: