Healthcare Provider Details

I. General information

NPI: 1609783422
Provider Name (Legal Business Name): MRS. GABRIELLE DESIRAE CONNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 OAKVALE RD
PRINCETON WV
24740-3828
US

IV. Provider business mailing address

421 ROARK RD
PRINCETON WV
24739-7774
US

V. Phone/Fax

Practice location:
  • Phone: 304-425-6530
  • Fax:
Mailing address:
  • Phone: 304-425-6530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: