Provider Demographics
NPI:1790063774
Name:CONLEY, SHANNON S (APRN)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:S
Last Name:CONLEY
Suffix:
Gender:F
Credentials:APRN
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Mailing Address - Street 1:1709 KY ROUTE 321 STE 3
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-9097
Mailing Address - Country:US
Mailing Address - Phone:606-886-8546
Mailing Address - Fax:606-886-8548
Practice Address - Street 1:835 PARKWAY DR
Practice Address - Street 2:
Practice Address - City:SALYERSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41465-9250
Practice Address - Country:US
Practice Address - Phone:606-349-5126
Practice Address - Fax:606-349-5127
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-25
Last Update Date:2012-01-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY3006976363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner