Individual
JACQUELINE R CLAYTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
1215 W MAIN ST, SHELBYVILLE, IL 62565-1252
(217) 774-4305
(217) 774-4306
Mailing address
1005 HEALTH CENTER DR STE 201, MATTOON, IL 61938-4693
(217) 238-6055
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
209-006100
IL
363LF0000X
Family Nurse Practitioner
Primary
277000144
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
309003069
—
IL
Enumeration date
07/22/2006
Last updated
01/15/2020
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