Healthcare Provider Details

I. General information

NPI: 1346619038
Provider Name (Legal Business Name): HOLLY LAUREN CLAYTON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2015
Last Update Date: 01/28/2020
Certification Date: 01/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BAYLOR PLZ
HOUSTON TX
77030-3411
US

IV. Provider business mailing address

10819 TEXAS ROSE DR
MISSOURI CITY TX
77459-1378
US

V. Phone/Fax

Practice location:
  • Phone: 713-798-4321
  • Fax:
Mailing address:
  • Phone: 832-331-9089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: