Provider Demographics
NPI:1023219680
Name:PATRICIA CONKLING CNP LLC
Entity Type:Organization
Organization Name:PATRICIA CONKLING CNP LLC
Other - Org Name:MEADOWLARK FAMILY HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CERTIFIED NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CONKLING
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:505-891-9990
Mailing Address - Street 1:4200 MEADOWLARK LN SE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1050
Mailing Address - Country:US
Mailing Address - Phone:505-981-9990
Mailing Address - Fax:505-891-9007
Practice Address - Street 1:4200 MEADOWLARK LN SE
Practice Address - Street 2:SUITE 2
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1050
Practice Address - Country:US
Practice Address - Phone:505-981-9990
Practice Address - Fax:505-891-9007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR23886261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMN4251Medicaid
NMN4251Medicaid