Provider Demographics
NPI:1427368232
Name:PARKER, CLAYTEN LEE (FNP)
Entity type:Individual
Prefix:MR
First Name:CLAYTEN
Middle Name:LEE
Last Name:PARKER
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:944 VAN GERT DR
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-7914
Mailing Address - Country:US
Mailing Address - Phone:252-714-6201
Mailing Address - Fax:
Practice Address - Street 1:944 VAN GERT DR
Practice Address - Street 2:
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590-7914
Practice Address - Country:US
Practice Address - Phone:252-714-6201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC177054363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1427368232Medicaid
NCNCF3320322Medicare PIN