MEDICARE: KELLY L CONLEY RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN417169	OH
2	163WP0808X	Psychiatric/Mental Health Registered Nurse	RN.417169	OH

General Provider Information

NPI Number	:	1174983787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY L CONLEY RN

Provider Business Mailing Address
First Line	:	5439 BURKHARDT RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45431-2111
Country	:	US
Telephone Number	:	740-352-7289
Fax Number	:

Provider Business Practice Location Address
First Line	:	4384 RHODES AVE
Second Line	:
City	:	NEW BOSTON
State	:	OH
Zip	:	45662-5533
Country	:	US
Telephone Number	:	740-566-5600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2016
Last Update Date	:	03/20/2023

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