Provider Demographics
NPI:1205861929
Name:CONREY, LAURA KRISTIN (PA-C)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:KRISTIN
Last Name:CONREY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 CENTRAL PIKE STE 352
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-3421
Mailing Address - Country:US
Mailing Address - Phone:615-882-4000
Mailing Address - Fax:615-882-4002
Practice Address - Street 1:3901 CENTRAL PIKE STE 352
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-3421
Practice Address - Country:US
Practice Address - Phone:615-882-4000
Practice Address - Fax:615-882-4002
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA1092363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN11724090OtherCAQH
TN3663898Medicaid
TN3663899Medicare PIN