MEDICARE: KIARA N CLAY

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1558980961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIARA N CLAY

Provider Business Mailing Address
First Line	:	841 PRUDENTIAL DR STE 1200
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-8874
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	841 PRUDENTIAL DR STE 1200
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-8874
Country	:	US
Telephone Number	:	904-371-6532
Fax Number	:

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

Provider Enumeration Date	:	04/15/2020
Last Update Date	:	04/15/2020

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Directions to “ KIARA N CLAY ” Practice Location

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