Provider Demographics
NPI:1972112084
Name:THETFORD, CLAIRE
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:
Last Name:THETFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WALDEN RIDGE DR STE 20B
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-8598
Mailing Address - Country:US
Mailing Address - Phone:828-585-2178
Mailing Address - Fax:828-276-7923
Practice Address - Street 1:2 WALDEN RIDGE DR STE 20B
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-8598
Practice Address - Country:US
Practice Address - Phone:828-585-2178
Practice Address - Fax:828-276-7923
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-24
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant