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General NPI Number Information
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NPI Number | 1407669203
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Entity Type | Individual
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Provider Name | CLAY D MAXSON RN
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Gender | Male
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Dates
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Enumeration Date | 01/28/2025
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 1907 W SYCAMORE ST
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City | KOKOMO
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State | IN
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Zip | 46901-5148
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Country | US
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Telephone | 765-452-5611
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Fax |
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Provider Business Mailing Address
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Address Line | 216 PROMISE LN APT 303
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City | LAFAYETTE
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State | IN
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Zip | 47905-5052
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Country | US
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Telephone | 765-490-1147
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 28245948C
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 163WE0003X
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Taxonomy Name | Emergency Registered Nurse
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License Number | 28245948A
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License Number State | IN
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