Healthcare Provider Details

I. General information

NPI: 1790438653
Provider Name (Legal Business Name): CHARITY DANIELLE CLAYTON NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2022
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 HARRISON PARK DR
HARRISON TN
37341-9621
US

IV. Provider business mailing address

6800 HARRISON PARK DR
HARRISON TN
37341-9621
US

V. Phone/Fax

Practice location:
  • Phone: 423-344-7095
  • Fax: 423-344-7569
Mailing address:
  • Phone: 423-344-7095
  • Fax: 423-344-7569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number30733
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: