Basic Information
| Provider Information | |||||||||
| NPI: | 1487379038 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CLAY | ||||||||
| FirstName: | CASSANDRA | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 S INDIGO TER | ||||||||
| Address2: | |||||||||
| City: | SAINT JOHNS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322594478 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2301 ERWIN RD | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277054699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196812237 | ||||||||
| FaxNumber: | 9196818521 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2022 | ||||||||
| LastUpdateDate: | 10/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 0010-12680 | NC | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.