Provider Demographics
NPI:1386451524
Name:CONNER, CHIQUITA (CSA)
Entity type:Individual
Prefix:
First Name:CHIQUITA
Middle Name:
Last Name:CONNER
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6709 REBECCA LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40258-3011
Mailing Address - Country:US
Mailing Address - Phone:804-651-2688
Mailing Address - Fax:
Practice Address - Street 1:2112 RATCLIFFE AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40210-2252
Practice Address - Country:US
Practice Address - Phone:804-651-2688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker