Provider Demographics
NPI:1467602375
Name:CONLEY, DAVID CLARK JR (LPN)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:CLARK
Last Name:CONLEY
Suffix:JR
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 BEAVER CREEK RD
Mailing Address - Street 2:APT 904
Mailing Address - City:PIKETON
Mailing Address - State:OH
Mailing Address - Zip Code:45661-8100
Mailing Address - Country:US
Mailing Address - Phone:740-835-1670
Mailing Address - Fax:
Practice Address - Street 1:601 BEAVER CREEK RD
Practice Address - Street 2:APT 904
Practice Address - City:PIKETON
Practice Address - State:OH
Practice Address - Zip Code:45661-8100
Practice Address - Country:US
Practice Address - Phone:740-835-1670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-27
Last Update Date:2008-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH119771164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse