MEDICARE: KARA L CONLEY FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	60326	WV
2	363LF0000X	Family Nurse Practitioner	0024172649	VA

General Provider Information

NPI Number	:	1164768479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARA L CONLEY FNP-C

Provider Business Mailing Address
First Line	:	4003 COLLEGE AVE
Second Line	:
City	:	BLUEFIELD
State	:	VA
Zip	:	24605-2043
Country	:	US
Telephone Number	:	276-322-2085
Fax Number	:

Provider Business Practice Location Address
First Line	:	340 PEPPERS FERRY RD
Second Line	:
City	:	WYTHEVILLE
State	:	VA
Zip	:	24382-2091
Country	:	US
Telephone Number	:	276-250-1675
Fax Number	:	206-203-0141

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2012
Last Update Date	:	10/04/2019

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