Provider Demographics
NPI:1518157023
Name:EXLEY, SUSAN K (APRN-BC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:K
Last Name:EXLEY
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:K
Other - Last Name:DAUGHERTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-BC
Mailing Address - Street 1:4425 PAULSEN ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-3662
Mailing Address - Country:US
Mailing Address - Phone:912-355-6615
Mailing Address - Fax:912-351-0645
Practice Address - Street 1:4425 PAULSEN ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-3662
Practice Address - Country:US
Practice Address - Phone:912-355-6615
Practice Address - Fax:912-351-0645
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN080817363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP1799Medicaid
GA042039204BMedicaid
GA595166OtherWELLCARE
GA595166OtherWELLCARE