Provider Demographics
NPI:1376828210
Name:CONLEY, JESSICA FAY (BA)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:FAY
Last Name:CONLEY
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 S JONES BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-1259
Mailing Address - Country:US
Mailing Address - Phone:702-257-9638
Mailing Address - Fax:702-974-1653
Practice Address - Street 1:1811 S JONES BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-1259
Practice Address - Country:US
Practice Address - Phone:702-257-9638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No104100000XBehavioral Health & Social Service ProvidersSocial Worker