Provider Demographics
NPI:1720798606
Name:CONLEY, LARRY TRENT (PMHNP)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:TRENT
Last Name:CONLEY
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2451 BIG BRANCH ROAD
Mailing Address - Street 2:
Mailing Address - City:HINDMAN
Mailing Address - State:KY
Mailing Address - Zip Code:41822
Mailing Address - Country:US
Mailing Address - Phone:606-497-5828
Mailing Address - Fax:
Practice Address - Street 1:1908 N MAIN ST STE 240
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-2503
Practice Address - Country:US
Practice Address - Phone:606-439-2662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3018666363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health