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General NPI Number Information
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NPI Number | 1790303816
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Entity Type | Individual
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Provider Name | COMANECHI CLAYTON PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/07/2020
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Last Update Date | 10/23/2023
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Provider Practice Location Address
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Address Line | 1821 HIGHWAY 39 N STE K
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City | MERIDIAN
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State | MS
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Zip | 39301-2725
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Country | US
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Telephone | 601-627-0257
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Fax | 601-258-4682
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Provider Business Mailing Address
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Address Line | 1821 HIGHWAY 39 N STE K
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City | MERIDIAN
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State | MS
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Zip | 39301-2725
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Country | US
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Telephone | 601-627-0257
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Fax | 601-258-4682
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 1-160325
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 903953
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License Number State | MS
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