Provider Demographics
NPI:1477635407
Name:CONGER, JOANN (RN)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:CONGER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TENNESSEE RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37178-4003
Mailing Address - Country:US
Mailing Address - Phone:731-642-0521
Mailing Address - Fax:
Practice Address - Street 1:1330 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TENNESSEE RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37178-4003
Practice Address - Country:US
Practice Address - Phone:731-642-0521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN133926163WG0000X
TNRN50442163WP0808X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5441449Medicaid