Healthcare Provider Details

I. General information

NPI: 1013348671
Provider Name (Legal Business Name): ERICA C CONLEY MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2013
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4011 RUBY ROSE RD
RICHMOND KY
40475-8429
US

IV. Provider business mailing address

4011 RUBY ROSE RD
RICHMOND KY
40475-8429
US

V. Phone/Fax

Practice location:
  • Phone: 270-860-9594
  • Fax:
Mailing address:
  • Phone: 270-860-9594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number1004
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: