Provider Demographics
NPI:1740901149
Name:CLIFTON, CARLEY MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:CARLEY
Middle Name:MARIE
Last Name:CLIFTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CARLEY
Other - Middle Name:
Other - Last Name:BURRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14391 LIMERICK LN
Mailing Address - Street 2:
Mailing Address - City:CEMENT CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49233-9046
Mailing Address - Country:US
Mailing Address - Phone:517-262-0128
Mailing Address - Fax:
Practice Address - Street 1:5433 S OCCIDENTAL RD STE C
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:MI
Practice Address - Zip Code:49286-9782
Practice Address - Country:US
Practice Address - Phone:517-423-3901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant