Provider Demographics
NPI:1174244651
Name:CLEARY, KARMON JO (FNP-C)
Entity type:Individual
Prefix:
First Name:KARMON
Middle Name:JO
Last Name:CLEARY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 S PALISADE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-8905
Mailing Address - Country:US
Mailing Address - Phone:805-739-3968
Mailing Address - Fax:805-739-3051
Practice Address - Street 1:116 S PALISADE DR STE 200
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-8905
Practice Address - Country:US
Practice Address - Phone:805-739-3968
Practice Address - Fax:805-739-3051
Is Sole Proprietor?:No
Enumeration Date:2022-09-05
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95020771363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily