Basic Information
Provider Information
NPI: 1346223419
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CLAYTON
FirstName: BRIAN
MiddleName: L
NamePrefix: MR.
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 110 29TH AVE N STE 202
Address2:  
City: NASHVILLE
State: TN
PostalCode: 372031448
CountryCode: US
TelephoneNumber: 6153274304
FaxNumber:  
Practice Location
Address1: 110 29TH AVE N
Address2: SUITE 301
City: NASHVILLE
State: TN
PostalCode: 372031401
CountryCode: US
TelephoneNumber: 6153274304
FaxNumber: 6153277940
Other Information
ProviderEnumerationDate: 11/22/2005
LastUpdateDate: 12/20/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000X13283TNY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 
367500000XRN0000167956TNN Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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