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General NPI Number Information
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NPI Number | 1790108165
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Entity Type | Individual
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Provider Name | AMBER RANEE CONRAD PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/21/2014
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Last Update Date | 03/25/2024
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Provider Practice Location Address
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Address Line | 1906 BELLEVIEW AVE SE
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City | ROANOKE
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State | VA
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Zip | 24014-1838
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Country | US
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Telephone | 540-853-0711
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Fax |
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Provider Business Mailing Address
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Address Line | 2119 HANOVER AVE NW
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City | ROANOKE
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State | VA
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Zip | 24017-6207
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Country | US
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Telephone | 910-568-9495
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0110-004456
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-04671
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License Number State | NC
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