Provider Demographics
NPI:1245267095
Name:CONRAD, CHERYL (FNP)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:CONRAD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MED TECH PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-4001
Mailing Address - Country:US
Mailing Address - Phone:423-232-6120
Mailing Address - Fax:423-232-6125
Practice Address - Street 1:101 MED TECH PKWY STE 200
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-4001
Practice Address - Country:US
Practice Address - Phone:423-232-6120
Practice Address - Fax:423-232-6125
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8007363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3909234Medicaid
TN4122083OtherBLUE CROSS BLUE SHIELD
TN4122083OtherBLUE CROSS BLUE SHIELD
TN3909234Medicare ID - Type Unspecified