Provider Demographics
NPI:1174049449
Name:CLAYTON, STANLEY ALAN (FNP)
Entity type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:ALAN
Last Name:CLAYTON
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 1:14354 TIMBER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LOXLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36551-5425
Mailing Address - Country:US
Mailing Address - Phone:251-458-8682
Mailing Address - Fax:
Practice Address - Street 1:6901 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-3795
Practice Address - Country:US
Practice Address - Phone:251-634-2278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1090502363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily