Provider Demographics
NPI:1194034991
Name:CONLEY, MICHELLE LYNN (ICD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:CONLEY
Suffix:
Gender:F
Credentials:ICD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 DRY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:TELLICO PLAINS
Mailing Address - State:TN
Mailing Address - Zip Code:37385-5740
Mailing Address - Country:US
Mailing Address - Phone:423-836-3352
Mailing Address - Fax:
Practice Address - Street 1:207 DRY CREEK RD
Practice Address - Street 2:
Practice Address - City:TELLICO PLAINS
Practice Address - State:TN
Practice Address - Zip Code:37385-5740
Practice Address - Country:US
Practice Address - Phone:423-836-3352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula