=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144141862
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CLAYTON ROBERT VANCE FNP-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2026
-----------------------------------------------------
Last Update Date | 07/21/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 170 MOUSE CREEK RD NW
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37312-3840
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-458-1426
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7425 KEELY RUN
-----------------------------------------------------
City | OOLTEWAH
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37363-1400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-375-5055
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 42365
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------