Healthcare Provider Details

I. General information

NPI: 1780546259
Provider Name (Legal Business Name): LYNETTE CLAYTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 COMANCHE RD
FORT MEADE SD
57741-1002
US

IV. Provider business mailing address

1908 COWBOY LN
SPEARFISH SD
57783-9565
US

V. Phone/Fax

Practice location:
  • Phone: 303-374-4001
  • Fax:
Mailing address:
  • Phone: 303-374-4001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCP003950
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: