Healthcare Provider Details

I. General information

NPI: 1861498495
Provider Name (Legal Business Name): LISA RENAY CLAYTON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 INDIANA ST
ASHLAND OR
97520-0071
US

IV. Provider business mailing address

931 CHEVY WAY
MEDFORD OR
97504-4127
US

V. Phone/Fax

Practice location:
  • Phone: 541-535-6239
  • Fax:
Mailing address:
  • Phone: 541-535-6239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200150045
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: