Provider Demographics
NPI:1295122570
Name:CONLEY, MONICA
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:CONLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14881 ANGELA DR
Mailing Address - Street 2:14881 ANGELA DRIVE
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-3552
Mailing Address - Country:US
Mailing Address - Phone:228-437-7033
Mailing Address - Fax:800-788-0393
Practice Address - Street 1:14881 ANGELA DR
Practice Address - Street 2:14881 ANGELA DRIVE
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-3552
Practice Address - Country:US
Practice Address - Phone:228-437-7033
Practice Address - Fax:800-788-0393
Is Sole Proprietor?:No
Enumeration Date:2015-04-23
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0045433747A0650X, 376J00000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No376J00000XNursing Service Related ProvidersHomemaker