Provider Demographics
NPI:1073338539
Name:CLAYTON, JESSICA LEA (RN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEA
Last Name:CLAYTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LEA
Other - Last Name:BLEEKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:190 N RANDOLPH ST
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:IA
Mailing Address - Zip Code:50461-8050
Mailing Address - Country:US
Mailing Address - Phone:641-832-7333
Mailing Address - Fax:641-732-6030
Practice Address - Street 1:616 N 8TH ST
Practice Address - Street 2:
Practice Address - City:OSAGE
Practice Address - State:IA
Practice Address - Zip Code:50461-1456
Practice Address - Country:US
Practice Address - Phone:641-732-6007
Practice Address - Fax:641-732-6030
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1579844163W00000X
IA113943163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse