Healthcare Provider Details

I. General information

NPI: 1205861929
Provider Name (Legal Business Name): LAURA KRISTIN CONREY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5653 FRIST BLVD STE 236
HERMITAGE TN
37076-2063
US

IV. Provider business mailing address

1275 DICK LONAS RD UNIT 101
KNOXVILLE TN
37909-1383
US

V. Phone/Fax

Practice location:
  • Phone: 615-232-8812
  • Fax: 615-232-8815
Mailing address:
  • Phone: 865-584-4747
  • Fax: 865-381-1509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1092
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: