Organization
KELLY CLAYTON FNP INC
Active
Other names
Health Care By House Call
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY MARIE CLAYTON FNP (PRESIDENT)
(541) 878-3537
Entity
Organization
Contact information
Practice address
387 PINETOP TERRACE, SHADY COVE, OR 97539
(541) 878-3537
Mailing address
PO BOX 1, SHADY COVE, OR 97539-0001
(541) 878-3537
(541) 878-0990
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
200150078NP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1396744769
INDIVIDUAL NPI
OR
05
—
228862
—
OR
Enumeration date
07/08/2008
Last updated
07/08/2008
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