Healthcare Provider Details

I. General information

NPI: 1194034991
Provider Name (Legal Business Name): MICHELLE LYNN CONLEY ICD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2010
Last Update Date: 09/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 DRY CREEK RD
TELLICO PLAINS TN
37385-5740
US

IV. Provider business mailing address

207 DRY CREEK RD
TELLICO PLAINS TN
37385-5740
US

V. Phone/Fax

Practice location:
  • Phone: 423-836-3352
  • Fax:
Mailing address:
  • Phone: 423-836-3352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: