Lacy Rae Clayton, RN, NP, DNP
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Wyncote, PA
NPI 1508166281 · NPPES record last updated Apr 22, 2023
Key facts
- NPI
- 1508166281
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- SP015382 (PA)
- Practice address
- 102 Waverly Rd
Wyncote, PA 19095-1322 - Phone
- (267) 944-6220
- NPI assigned
- Oct 27, 2010
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151207000877 | PA | Practitioner - Nurse Practitioner | 5799085288 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner, Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN2269120 | MA | MD | Psychiatric/Mental Health Nurse Practitioner |
| SP015382 | PA | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Springfield Psychological PC | Current |
Accepting new patients | |
| Lacy Clayton Wellness | Psychiatric/Mental Health | Current |
Accepting new patients |
Locations
1489 Baltimore Pike
Ste 250
Springfield, PA 19064
Phone 6105442110144
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | SP015382 | PA | Yes |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | RN2269120 | MA |
Addresses
Primary practice location
102 Waverly Rd
Wyncote, PA 19095-1322
Mailing address
102 Waverly Rd
Wyncote, PA 19095-1322
Phone (267) 944-6220
Other providers in Wyncote, PA
- Antonia Clanton
- Clarity Acupuncture
- Beth Clarke
- Charles Clayton Jr.
- Kyle Andrew Clayton
- Melissa Lynn Clugston
- Ann L Colley
- Luis Antonio Colon
- Comfort Space Home Care LLC
- Megan Conville
All providers in Wyncote, PA · Psychiatric/Mental Health Nurse Practitioner in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 22, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.