Individual
MRS. ALICIA MARIE CONN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP, PMHNP-BC
Contact information
Practice address
6205 FOX RUN CIR, BLACKSHEAR, GA 31516-5322
(912) 670-0808
Mailing address
6205 FOX RUN CIR, BLACKSHEAR, GA 31516-5322
(912) 670-0808
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
RN230326
GA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
000000
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003254260A
—
GA
Enumeration date
01/03/2017
Last updated
04/14/2025
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