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NPI Code Detail

MEDICARE: HATTIE DENICE CLAYTON PMHNP

MEDICARE: HATTIE DENICE CLAYTON PMHNP
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner2018082894NC

General Provider Information

NPI Number : 1396209250
Entity Type Code : Individual
Provider Name (Legal Business Name) : HATTIE DENICE CLAYTON PMHNP
Provider Business Mailing Address
First Line : 90 SOUTHSIDE AVE STE 350
Second Line :
City : ASHEVILLE
State : NC
Zip : 28801-4184
Country : US
Telephone Number : 828-210-2042
Fax Number : 828-240-2043
Provider Business Practice Location Address
First Line : 1 MARITHE CT
Second Line :
City : GREENSBORO
State : NC
Zip : 27407-2702
Country : US
Telephone Number : 828-210-2042
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2019
Last Update Date : 01/24/2019

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