Healthcare Provider Details

I. General information

NPI: 1760650261
Provider Name (Legal Business Name): ELIZABETH T CONLEY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2008
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 S LIMESTONE STE J107
LEXINGTON KY
40536-2701
US

IV. Provider business mailing address

1221 S BROADWAY
LEXINGTON KY
40504-2701
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-5603
  • Fax: 859-323-3704
Mailing address:
  • Phone: 859-258-6360
  • Fax: 859-276-2392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA930
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA930
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA930
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: