Provider Demographics
NPI:1427146562
Name:CLAY, JOHN GLENN (APRN)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:GLENN
Last Name:CLAY
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 ADMIRAL TAUSSIG BLVD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23511-2802
Mailing Address - Country:US
Mailing Address - Phone:757-953-8481
Mailing Address - Fax:
Practice Address - Street 1:399 DIEDERICH BLVD
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7007
Practice Address - Country:US
Practice Address - Phone:606-324-2055
Practice Address - Fax:606-324-3808
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.05468363L00000X
KY3002990363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2356034Medicaid
KY78003639Medicaid
OHN054415Medicare ID - Type Unspecified
OHN05414Medicare ID - Type Unspecified
KY78003639Medicaid
OHN054413Medicare ID - Type Unspecified
OHN054412Medicare ID - Type Unspecified