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General NPI Number Information
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NPI Number | 1336463660
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Entity Type | Organization
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Legal Business Name | CLAY HUBBLE FNP LLC
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Dates
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Enumeration Date | 03/15/2010
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Last Update Date | 03/15/2010
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Provider Practice Location Address
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Address Line | 69304 PREVOST RD
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City | MANDEVILLE
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State | LA
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Zip | 70471-7702
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Country | US
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Telephone | 985-234-9450
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Fax | 985-234-9450
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Provider Business Mailing Address
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Address Line | 69304 PREVOST RD
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City | MANDEVILLE
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State | LA
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Zip | 70471-7702
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Country | US
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Telephone | 985-234-9450
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Fax | 985-234-9450
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MR. CLAY J HUBBLE III
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Credential | FNP
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Telephone | 985-234-9450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP05824
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License Number State | LA
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