Provider Demographics
NPI:1053431973
Name:CONNER, PATRICIA J (MD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:J
Last Name:CONNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 MEDICAL PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-7343
Mailing Address - Country:US
Mailing Address - Phone:423-989-4050
Mailing Address - Fax:423-990-3044
Practice Address - Street 1:111 MOCKINGBIRD AVE
Practice Address - Street 2:
Practice Address - City:PARROTTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37843
Practice Address - Country:US
Practice Address - Phone:423-625-1170
Practice Address - Fax:423-625-3618
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD41976207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN30002664Medicaid
TN4156963OtherBCBST
TN4156961OtherBCBST
TN30002661Medicaid
TN30002662Medicaid
TN4156962OtherBCBST
TN4156943OtherBCBST
TN3000266Medicaid
TN30002663Medicaid
TN4156964OtherBCBST
TN30002664Medicare PIN
TN30002663Medicare PIN
TN30002662Medicare PIN
TN30002661Medicare PIN
TN30002663Medicaid