Virginia Lea Conner, EDD

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

1004 Issued in AZ

Practice address

141 S McCormick St Ste 109
Prescott, AZ 86303

Phone

(928) 710-8800

Fax

(928) 777-8020

NPI assigned

Apr 10, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530057600000",
    "number": "1295958023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 S MCCORMICK ST STE 109",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863034730",
            "telephone_number": "928-710-8800",
            "fax_number": "928-777-8020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "141 S MCCORMICK ST STE 109",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "86303",
            "telephone_number": "928-710-8800",
            "fax_number": "928-777-8020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNER",
        "first_name": "VIRGINIA",
        "middle_name": "LEA",
        "credential": "EDD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-10",
        "last_updated": "2018-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "AZ",
            "license": "1004",
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "AZ",
            "license": "1004",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL ID NUMBER",
            "identifier": "860969406",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Neuropsychologist in Prescott, AZ
• Providers in Prescott, AZ by specialty
• Clinical Neuropsychologist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.