Provider Demographics
NPI:1922489608
Name:CONERLY, KRYSTAL MICHELLE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:KRYSTAL
Middle Name:MICHELLE
Last Name:CONERLY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 JEFF DAVIS BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-5140
Mailing Address - Country:US
Mailing Address - Phone:601-442-9802
Mailing Address - Fax:
Practice Address - Street 1:151 JEFF DAVIS BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-5140
Practice Address - Country:US
Practice Address - Phone:601-442-9802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-17
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR891875363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily