Provider Demographics
NPI:1457831497
Name:CONKLIN CLINICS, PROF LLC
Entity Type:Organization
Organization Name:CONKLIN CLINICS, PROF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CNP
Authorized Official - Prefix:DR
Authorized Official - First Name:GINGER
Authorized Official - Middle Name:H
Authorized Official - Last Name:CONKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, PMHNP
Authorized Official - Phone:605-725-4772
Mailing Address - Street 1:2120 8TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401
Mailing Address - Country:US
Mailing Address - Phone:605-725-4772
Mailing Address - Fax:605-725-4777
Practice Address - Street 1:2120 8TH AVE NE
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401
Practice Address - Country:US
Practice Address - Phone:605-725-4357
Practice Address - Fax:605-725-4777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-20
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RH0003X, 261QM1300X, 363LF0000X
SDCP001402363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty