Healthcare Provider Details

I. General information

NPI: 1396289450
Provider Name (Legal Business Name): DOUGLAS KENDALL CONLEY FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2016
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17301 E SPRING VALLEY RD STE F
SPRING VALLEY AZ
86333-4263
US

IV. Provider business mailing address

17301 E SPRING VALLEY RD STE F
SPRING VALLEY AZ
86333-4263
US

V. Phone/Fax

Practice location:
  • Phone: 928-632-4909
  • Fax:
Mailing address:
  • Phone: 928-632-4909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP9724
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: