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General NPI Number Information
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NPI Number | 1740604446
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Entity Type | Organization
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Legal Business Name | COMMONWEALTH PSYCHIATRY, PLLC
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Dates
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Enumeration Date | 02/15/2014
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Last Update Date | 02/15/2014
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Provider Practice Location Address
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Address Line | 412 S 4TH ST STE A
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City | DANVILLE
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State | KY
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Zip | 40422-2007
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Country | US
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Telephone | 859-236-0840
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Fax | 859-236-0841
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Provider Business Mailing Address
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Address Line | 412 S 4TH ST STE A
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City | DANVILLE
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State | KY
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Zip | 40422-2007
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Country | US
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Telephone | 859-236-0840
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Fax | 859-236-0841
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Authorized Official
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Title or Position | OWNER
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Name | DR. MELISSA KAY CONNER
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Credential | MD
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Telephone | 859-236-0840
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 34511
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License Number State | KY
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