Provider Demographics
NPI:1003513698
Name:CONKLIN, TRISHA ANN
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:ANN
Last Name:CONKLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TRISHA
Other - Middle Name:ANN
Other - Last Name:MOFFETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1171 SHORT RD
Mailing Address - Street 2:
Mailing Address - City:ALMO
Mailing Address - State:KY
Mailing Address - Zip Code:42020-9392
Mailing Address - Country:US
Mailing Address - Phone:270-978-3352
Mailing Address - Fax:
Practice Address - Street 1:1171 SHORT RD
Practice Address - Street 2:
Practice Address - City:ALMO
Practice Address - State:KY
Practice Address - Zip Code:42020-9392
Practice Address - Country:US
Practice Address - Phone:270-978-3352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist