Provider Demographics
NPI:1578004925
Name:CONKLIN, JESSICA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:CONKLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20410 CENTURY BLVD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-1186
Mailing Address - Country:US
Mailing Address - Phone:301-540-5190
Mailing Address - Fax:
Practice Address - Street 1:2900 S HANOVER ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:MD
Practice Address - Zip Code:21225-1232
Practice Address - Country:US
Practice Address - Phone:410-350-8372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-19
Last Update Date:2017-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program