Provider Demographics
NPI:1326316019
Name:DEERING, SUSAN (ACNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:DEERING
Suffix:
Gender:F
Credentials:ACNP
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 35629
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-0629
Mailing Address - Country:US
Mailing Address - Phone:214-424-2200
Mailing Address - Fax:214-231-2159
Practice Address - Street 1:900 W MAGNOLIA AVE
Practice Address - Street 2:STE 100
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-8517
Practice Address - Country:US
Practice Address - Phone:817-870-7300
Practice Address - Fax:817-335-9529
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX632014364SA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5011140OtherCIGNA
TX8477NZOtherBLUE CROSS BLUE SHIELD
TX546053YPGSMedicare PIN