Healthcare Provider Details

I. General information

NPI: 1982296281
Provider Name (Legal Business Name): KORI BRIANNE CONLON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2021
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 CROW CANYON CT STE 100
SAN RAMON CA
94583-1650
US

IV. Provider business mailing address

6 CROW CANYON CT STE 100
SAN RAMON CA
94583-1650
US

V. Phone/Fax

Practice location:
  • Phone: 925-838-8830
  • Fax: 925-838-8836
Mailing address:
  • Phone: 925-549-1188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number68032
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: