Clayton, Jacqueline R

Clayton, Jacqueline R is an individual health care provider with primary practice located at 1215 W Main St , Shelbyville IL 62565-1252. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Clayton, Jacqueline R can be contacted via phone (217) 774-4305.

Contact Information

Primary practice address
1215 W Main St Shelbyville IL 62565-1252
Phone: (217) 774-4305
Fax: (217) 774-4306
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 277000144 Illinois
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 209-006100 Illinois

Profile Details

NPI number 1821019969
LBN Legal business name Clayton, Jacqueline R
Credentials Advanced Practice Nurse (APN)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 22nd, 2006
Last updated Jan 15th, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1821019969 NPPES
Illinois MEDICAID 309003069

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