Provider Demographics
NPI:1972919165
Name:CONLEY, ERICA (CRNP)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:CONLEY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 AVALON AVE
Mailing Address - Street 2:
Mailing Address - City:MUSCLE SHOALS
Mailing Address - State:AL
Mailing Address - Zip Code:35661-2804
Mailing Address - Country:US
Mailing Address - Phone:256-826-1001
Mailing Address - Fax:256-978-5118
Practice Address - Street 1:210 AVALON AVE
Practice Address - Street 2:
Practice Address - City:MUSCLE SHOALS
Practice Address - State:AL
Practice Address - Zip Code:35661
Practice Address - Country:US
Practice Address - Phone:256-826-1001
Practice Address - Fax:256-978-5118
Is Sole Proprietor?:No
Enumeration Date:2014-07-08
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-126360363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL165400Medicaid