Provider Demographics
NPI:1215560511
Name:CONLEY, JAMIE KATHLEEN (CPHT)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:KATHLEEN
Last Name:CONLEY
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 E END BLVD N
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75670-3603
Mailing Address - Country:US
Mailing Address - Phone:903-938-3096
Mailing Address - Fax:
Practice Address - Street 1:207 E END BLVD N
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670-3603
Practice Address - Country:US
Practice Address - Phone:903-938-3096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-15
Last Update Date:2020-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX262441183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician