Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 71011354A | IN |
NPI | 1912570292 |
---|---|
Provider Name | Jason E Clay |
First Address | Goshen, IN 46528-7100 |
Second Address | Goshen, IN 46528-7100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2021 |
Last Update Date | 23/07/2021 |