Healthcare Provider Details

I. General information

NPI: 1144141862
Provider Name (Legal Business Name): CLAYTON ROBERT VANCE FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 MOUSE CREEK RD NW
CLEVELAND TN
37312-3840
US

IV. Provider business mailing address

7425 KEELY RUN
OOLTEWAH TN
37363-1400
US

V. Phone/Fax

Practice location:
  • Phone: 423-458-1426
  • Fax:
Mailing address:
  • Phone: 949-375-5055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number42365
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: