Basic Information
| Provider Information | |||||||||
| NPI: | 1053431973 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CONNER | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 208 MEDICAL PARK BLVD | ||||||||
| Address2: | |||||||||
| City: | BRISTOL | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376207343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239894050 | ||||||||
| FaxNumber: | 4239903044 | ||||||||
| Practice Location | |||||||||
| Address1: | 111 MOCKINGBIRD AVE | ||||||||
| Address2: | |||||||||
| City: | PARROTTSVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37843 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4236251170 | ||||||||
| FaxNumber: | 4236253618 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2007 | ||||||||
| LastUpdateDate: | 06/12/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD41976 | TN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 30002664 | 05 | TN | MEDICAID | 4156963 | 01 | TN | BCBST | OTHER | 4156961 | 01 | TN | BCBST | OTHER | 30002661 | 05 | TN | MEDICAID | 30002662 | 05 | TN | MEDICAID | 4156962 | 01 | TN | BCBST | OTHER | 4156943 | 01 | TN | BCBST | OTHER | 3000266 | 05 | TN | MEDICAID | 30002663 | 05 | TN | MEDICAID | 4156964 | 01 | TN | BCBST | OTHER |