Provider Demographics
NPI:1679980551
Name:CONNLEY, KATY (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:KATY
Middle Name:
Last Name:CONNLEY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 E PLAZA DR STE 110
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-6567
Mailing Address - Country:US
Mailing Address - Phone:208-274-9850
Mailing Address - Fax:208-367-7316
Practice Address - Street 1:951 E PLAZA DR STE 110
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-6567
Practice Address - Country:US
Practice Address - Phone:208-274-9850
Practice Address - Fax:208-274-9581
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-12
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-1451A207RE0101X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily