Provider Demographics
NPI:1598831596
Name:CLAY, RICKEY EDWARD (LVN)
Entity type:Individual
Prefix:
First Name:RICKEY
Middle Name:EDWARD
Last Name:CLAY
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:939 MARKET ST
Mailing Address - Street 2:4TH FL.
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-1706
Mailing Address - Country:US
Mailing Address - Phone:415-597-8082
Mailing Address - Fax:415-597-8004
Practice Address - Street 1:939 MARKET ST
Practice Address - Street 2:4TH FL.
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-1706
Practice Address - Country:US
Practice Address - Phone:415-597-8082
Practice Address - Fax:415-597-8004
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 88647164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse