Healthcare Provider Details

I. General information

NPI: 1922783984
Provider Name (Legal Business Name): PAULA RENEE CONNOR IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8310 FRONT GATE CIR
OOLTEWAH TN
37363-9506
US

IV. Provider business mailing address

8310 FRONT GATE CIR
OOLTEWAH TN
37363-9506
US

V. Phone/Fax

Practice location:
  • Phone: 334-303-0766
  • Fax:
Mailing address:
  • Phone: 334-303-0766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-126567
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: