Provider Demographics
NPI:1538604368
Name:CONN, ALICIA MARIE (FNP, PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:MARIE
Last Name:CONN
Suffix:
Gender:
Credentials:FNP, PMHNP-BC
Other - Prefix:MS
Other - First Name:ALICIA
Other - Middle Name:MARIE
Other - Last Name:THRIFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C, PMHNP-BC
Mailing Address - Street 1:6205 FOX RUN CIR
Mailing Address - Street 2:
Mailing Address - City:BLACKSHEAR
Mailing Address - State:GA
Mailing Address - Zip Code:31516-5322
Mailing Address - Country:US
Mailing Address - Phone:912-670-0808
Mailing Address - Fax:
Practice Address - Street 1:6205 FOX RUN CIR
Practice Address - Street 2:
Practice Address - City:BLACKSHEAR
Practice Address - State:GA
Practice Address - Zip Code:31516-5322
Practice Address - Country:US
Practice Address - Phone:912-670-0808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-03
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN230326363LF0000X
GA000000363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003254260AMedicaid