=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124662218
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ADRIENNE CLAYTON APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/31/2019
-----------------------------------------------------
Last Update Date | 07/29/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1700 CENTER ST
-----------------------------------------------------
City | MOBILE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36604-3301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-415-1055
-----------------------------------------------------
Fax | 251-415-1045
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 746450
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30374-6450
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-401-3057
-----------------------------------------------------
Fax | 318-868-6430
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WN0002X
-----------------------------------------------------
Taxonomy Name | Neonatal Intensive Care Registered Nurse
-----------------------------------------------------
License Number | RN9357420
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LN0000X
-----------------------------------------------------
Taxonomy Name | Neonatal Nurse Practitioner
-----------------------------------------------------
License Number | APRN11006005
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363LN0000X
-----------------------------------------------------
Taxonomy Name | Neonatal Nurse Practitioner
-----------------------------------------------------
License Number | 3-001769
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------