Provider Demographics
NPI:1356332365
Name:CONKLING, PATRICIA (CNP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:CONKLING
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 MEADOWLARK LN SE
Mailing Address - Street 2:STE 2
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1050
Mailing Address - Country:US
Mailing Address - Phone:505-891-9990
Mailing Address - Fax:505-891-9007
Practice Address - Street 1:4200 MEADOWLARK LN SE
Practice Address - Street 2:STE 2
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1050
Practice Address - Country:US
Practice Address - Phone:505-891-9990
Practice Address - Fax:505-891-9007
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2013-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR23886363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMPROVP12369OtherMOLINA SALUD
NM200601944OtherPHP
NM10000021OtherLHP
NM27986756Medicaid
NMNM026863OtherBCBS
NMP00302877OtherRAILROAD MEDICARE
NM341411408Medicare PIN
NMNM026863OtherBCBS