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General NPI Number Information
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NPI Number | 1972726925
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Entity Type | Individual
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Provider Name | MRS. JUDY LEE CONLEY
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Gender | Female
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 4611 LONG FORK RD
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City | PIKETON
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State | OH
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Zip | 45661-9033
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Country | US
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Telephone | 740-289-3877
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Fax | 740-289-3877
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Provider Business Mailing Address
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Address Line | 4611 LONG FORK RD
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City | PIKETON
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State | OH
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Zip | 45661-9033
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Country | US
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Telephone | 740-289-3877
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Fax | 740-289-3877
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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 | 171W00000X
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Taxonomy Name | Contractor
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License Number | 2591315
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License Number State | OH
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