Provider Demographics
NPI:1649666744
Name:CONLEY-DONALDSON, SHEREE (PHD, DNP, FNP, PMHNP)
Entity type:Individual
Prefix:DR
First Name:SHEREE
Middle Name:
Last Name:CONLEY-DONALDSON
Suffix:
Gender:F
Credentials:PHD, DNP, FNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 MILLPOND DRIVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-5559
Mailing Address - Country:US
Mailing Address - Phone:601-602-3161
Mailing Address - Fax:
Practice Address - Street 1:100 S 20TH AVE STE A
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-6043
Practice Address - Country:US
Practice Address - Phone:769-250-8054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-15
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR893659363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04959881Medicaid