Provider Demographics
NPI:1619524451
Name:CONLEY, TIM EUGENE
Entity Type:Individual
Prefix:
First Name:TIM
Middle Name:EUGENE
Last Name:CONLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 N WHITE TAIL CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-4174
Mailing Address - Country:US
Mailing Address - Phone:316-260-4420
Mailing Address - Fax:
Practice Address - Street 1:12202 E TROON ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-7805
Practice Address - Country:US
Practice Address - Phone:316-691-9397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider