Healthcare Provider Details

I. General information

NPI: 1508780636
Provider Name (Legal Business Name): JAMIE CONLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 19TH ST
WHEELING WV
26003-3715
US

IV. Provider business mailing address

111 SYCAMORE AVE
MOUNDSVILLE WV
26041-1242
US

V. Phone/Fax

Practice location:
  • Phone: 304-234-3500
  • Fax:
Mailing address:
  • Phone: 304-234-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: