Provider Demographics
NPI:1144472747
Name:CONRAD, BOBBIE J
Entity type:Individual
Prefix:MRS
First Name:BOBBIE
Middle Name:J
Last Name:CONRAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 HALLS BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:KY
Mailing Address - Zip Code:40380-8033
Mailing Address - Country:US
Mailing Address - Phone:606-663-0114
Mailing Address - Fax:606-663-0114
Practice Address - Street 1:165 HALLS BRANCH RD
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:KY
Practice Address - Zip Code:40380-8033
Practice Address - Country:US
Practice Address - Phone:606-663-0114
Practice Address - Fax:606-663-0114
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor