Clayton Edward McKiddy, ANP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

2013011243 Issued in MO

Practice address

969 N Mason Rd
Ste 160
Saint Louis, MO 63141-6338

Phone

(314) 996-3434

Fax

(314) 996-3595

NPI assigned

Jun 12, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Physician Groups LC

  • Multi-Specialty Clinic/Center
  • Saint Louis, MO
  • NPI 1285664268
  NPD (past)

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

{
    "created_epoch": "1370995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1370995200000",
    "number": "1861830838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "670 MASON RIDGE CENTER DR",
            "address_2": "STE 300",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418573",
            "telephone_number": "314-996-3434",
            "fax_number": "314-996-3595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "969 N MASON RD",
            "address_2": "STE 160",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631416338",
            "telephone_number": "314-996-3434",
            "fax_number": "314-996-3595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKIDDY",
        "first_name": "CLAYTON",
        "middle_name": "EDWARD",
        "credential": "ANP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-12",
        "last_updated": "2013-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MO",
            "license": "2013011243",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patricia Flynn McKenzie, B.C, A.N.P.
• Phoelica McKenzie, LCSW
• Eileen F. McKeon, ANP
• Erin McKeon, FNP-C
• Edward Cole McKeown, DPT
• Jackson W McKim, CAA
• Gretel A McKinley, ACNP
• Lisa McKinley
• Spencer McKinley
• Ava Lillian McKinney, MS, RD, LD

• Adult Health Nurse Practitioner in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Adult Health Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2013; 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.