Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | ARNP9414508 | FL |
NPI | 1003155110 |
---|---|
Provider Name | Billy Shannon Clay |
First Address | New Port Richey, FL 34653-4935 |
Second Address | New Port Richey, FL 34653-4935 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2013 |
Last Update Date | 15/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ARNP 9414508 | FL ARNP LICENSE (01) | FL |