Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | B48862 | AR |
NPI | 1003843277 |
---|---|
Provider Name | Miss Jo Ann Clay |
First Address | Conway, AR 72034-8131 |
Second Address | Conway, AR 72034-8131 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2006 |
Last Update Date | 30/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
255804 | COMPSYCH (01) | |
281471 | UBH (01) | |
787856000 | MAGELLAN (01) |