MEDICARE: MR. CLAYTON BALLOU THOMAS III RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WH0200X	Home Health Registered Nurse	901878	NV

General Provider Information

NPI Number	:	1235061888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CLAYTON BALLOU THOMAS III RN

Provider Business Mailing Address
First Line	:	8929 TRICKLING SPRINGS CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-2991
Country	:	US
Telephone Number	:	808-315-0322
Fax Number	:

Provider Business Practice Location Address
First Line	:	8929 TRICKLING SPRINGS CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-2991
Country	:	US
Telephone Number	:	808-315-0322
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2026
Last Update Date	:	05/29/2026

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