Provider Demographics
NPI:1467555839
Name:CONLEY, LORA LEIGH (PAC)
Entity Type:Individual
Prefix:MRS
First Name:LORA
Middle Name:LEIGH
Last Name:CONLEY
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MISS
Other - First Name:LORA
Other - Middle Name:LEIGH
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:535 N LAKE DR
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-1278
Mailing Address - Country:US
Mailing Address - Phone:606-886-8466
Mailing Address - Fax:606-886-0250
Practice Address - Street 1:535 N LAKE DR
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-1278
Practice Address - Country:US
Practice Address - Phone:606-886-8466
Practice Address - Fax:606-886-0250
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA943363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100370310Medicaid