Provider Demographics
NPI:1801546239
Name:CLAYTON, KRISTINA MANNING (DO)
Entity type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:MANNING
Last Name:CLAYTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MS
Other - First Name:KRISTINA
Other - Middle Name:MARIE
Other - Last Name:MANNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:105 PENINSULA DR
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38756-3019
Mailing Address - Country:US
Mailing Address - Phone:662-822-7849
Mailing Address - Fax:
Practice Address - Street 1:8300 CONSTANTIN BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3489
Practice Address - Country:US
Practice Address - Phone:662-822-7849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program