Provider Demographics
NPI:1114404209
Name:CEARLEY, SUZANNE (CPCP-PC)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:CEARLEY
Suffix:
Gender:F
Credentials:CPCP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2129
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79760-2129
Mailing Address - Country:US
Mailing Address - Phone:432-640-4860
Mailing Address - Fax:432-640-4864
Practice Address - Street 1:840 W CLEMENTS ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79763-4601
Practice Address - Country:US
Practice Address - Phone:432-640-4860
Practice Address - Fax:432-640-4864
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP138143363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics