1174956510 NPI number — MR. CLAY LAWRENCE HILL CFNP, APRN

Table of content: MR. CLAY LAWRENCE HILL CFNP, APRN (NPI 1174956510)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174956510 NPI number — MR. CLAY LAWRENCE HILL CFNP, APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HILL
Provider First Name:
CLAY
Provider Middle Name:
LAWRENCE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CFNP, APRN
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174956510
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/13/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 DOCTOR MICHAEL DEBAKEY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE CHARLES
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70601-5724
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-312-8258
Provider Business Mailing Address Fax Number:
337-312-6708

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1727 IMPERIAL BLVD
Provider Second Line Business Practice Location Address:
BLDG 2
Provider Business Practice Location Address City Name:
LAKE CHARLES
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70605-5362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-433-8400
Provider Business Practice Location Address Fax Number:
337-421-1408
Provider Enumeration Date:
08/20/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  AP07466 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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