Basic Information
| Provider Information | |||||||||
| NPI: | 1740531714 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLANTON | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | PAIGE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MSN, APN, A/GNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 20TH AVE N STE 403 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372032131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6298885125 | ||||||||
| FaxNumber: | 6298885126 | ||||||||
| Practice Location | |||||||||
| Address1: | 791 OLD HICKORY BLVD | ||||||||
| Address2: | |||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370274504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6298885125 | ||||||||
| FaxNumber: | 6298885126 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2012 | ||||||||
| LastUpdateDate: | 03/12/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 17040 | TN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 163W00000X | 182448 | TN | N | Nursing Service Providers | Registered Nurse | 363LA2200X | 17040 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 1531304 | 05 | TN | MEDICAID | 1035012I99 | 01 | TN | TN MEDICARE | OTHER |