Provider Demographics
NPI:1952441206
Name:FORD, CONNIE BIERLY (CNP)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:BIERLY
Last Name:FORD
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 ARDMORE DR
Mailing Address - Street 2:
Mailing Address - City:CEDARVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45314-9594
Mailing Address - Country:US
Mailing Address - Phone:937-766-1490
Mailing Address - Fax:
Practice Address - Street 1:2148 E MAIN ST
Practice Address - Street 2:CORNER CARE CLINIIC
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-4956
Practice Address - Country:US
Practice Address - Phone:937-525-0455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA 07481-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily