Provider Demographics
NPI:1891231437
Name:CONLEY, MARY ELLEN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELLEN
Last Name:CONLEY
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ELLEN
Other - Last Name:MULLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:1485 STRINGTOWN RD
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:KY
Mailing Address - Zip Code:41010
Mailing Address - Country:US
Mailing Address - Phone:859-469-1891
Mailing Address - Fax:
Practice Address - Street 1:100 MEDICAL CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701
Practice Address - Country:US
Practice Address - Phone:859-469-1891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3010937363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner