Provider Demographics
NPI:1023382348
Name:CHEESMAN, CONI C (PA)
Entity type:Individual
Prefix:MRS
First Name:CONI
Middle Name:C
Last Name:CHEESMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:CONI
Other - Middle Name:D
Other - Last Name:CLAYCAMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:2511 MANORWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-1888
Mailing Address - Country:US
Mailing Address - Phone:281-240-1086
Mailing Address - Fax:
Practice Address - Street 1:1 BAYLOR PLZ
Practice Address - Street 2:SUITE 225D
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3411
Practice Address - Country:US
Practice Address - Phone:713-798-6957
Practice Address - Fax:713-798-5162
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA1087363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant