Provider Demographics
NPI:1891670477
Name:NEELEY, MARISA LARAE (PA-C)
Entity type:Individual
Prefix:MS
First Name:MARISA
Middle Name:LARAE
Last Name:NEELEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3581 PALMER DR STE 602
Mailing Address - Street 2:
Mailing Address - City:CAMERON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:95682-8238
Mailing Address - Country:US
Mailing Address - Phone:530-672-7000
Mailing Address - Fax:
Practice Address - Street 1:3581 PALMER DR STE 602
Practice Address - Street 2:
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682-8238
Practice Address - Country:US
Practice Address - Phone:530-672-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA66873363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical