Provider Demographics
NPI:1235902438
Name:CONQUEST HEALTH, PLLC
Entity Type:Organization
Organization Name:CONQUEST HEALTH, PLLC
Other - Org Name:CONQUEST HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:PHELPS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:703-283-4215
Mailing Address - Street 1:15100 WASHINGTON ST STE 103
Mailing Address - Street 2:
Mailing Address - City:HAYMARKET
Mailing Address - State:VA
Mailing Address - Zip Code:20169-4919
Mailing Address - Country:US
Mailing Address - Phone:571-556-8205
Mailing Address - Fax:
Practice Address - Street 1:15100 WASHINGTON ST STE 103
Practice Address - Street 2:
Practice Address - City:HAYMARKET
Practice Address - State:VA
Practice Address - Zip Code:20169-4919
Practice Address - Country:US
Practice Address - Phone:571-556-8205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-31
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty