Provider Demographics
NPI:1275321085
Name:GRAVATT, CLAYTON MARK
Entity type:Individual
Prefix:
First Name:CLAYTON
Middle Name:MARK
Last Name:GRAVATT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSON
Mailing Address - State:NE
Mailing Address - Zip Code:68378-8304
Mailing Address - Country:US
Mailing Address - Phone:402-250-6042
Mailing Address - Fax:
Practice Address - Street 1:310 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:JOHNSON
Practice Address - State:NE
Practice Address - Zip Code:68378-8304
Practice Address - Country:US
Practice Address - Phone:402-250-6042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372600000XNursing Service Related ProvidersAdult Companion
No372500000XNursing Service Related ProvidersChore Provider