Individual provider Active NPI

Kaiya Clay

  • Pharmacist
  • McLeansville, NC
National Provider Identifier
1790372779
Registry record updated Dec 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
29245 Issued in NC
Practice address
5216 Cragganmore Dr
MC Leansville, NC 27301-9524
Phone
(336) 402-6813
NPI assigned
Dec 24, 2020
Last updated
Dec 24, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 24, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 29245 NC Primary

Addresses

Primary practice location

5216 Cragganmore Dr
MC Leansville, NC 27301-9524

Mailing address

625 S Van Buren Rd
Eden, NC 27288-5319

Other identifiers 1

IdentifierTypeStateIssuer
29245OtherNCLICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
29245NCMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1608768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608768000000",
    "number": "1790372779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 S VAN BUREN RD",
            "city": "EDEN",
            "state": "NC",
            "postal_code": "272885319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5216 CRAGGANMORE DR",
            "city": "MC LEANSVILLE",
            "state": "NC",
            "postal_code": "273019524",
            "telephone_number": "336-402-6813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLAY",
        "first_name": "KAIYA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-12-24",
        "last_updated": "2020-12-24",
        "certification_date": "2020-12-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NC",
            "license": "29245",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "29245",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in McLeansville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.