Provider Demographics
NPI:1619440450
Name:WISHING WELL CHILDREN'S CLINIC, PLLC
Entity Type:Organization
Organization Name:WISHING WELL CHILDREN'S CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ROSABELLE
Authorized Official - Middle Name:VIA
Authorized Official - Last Name:MCCONKEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-856-4600
Mailing Address - Street 1:1259 FM 1463
Mailing Address - Street 2:SUITE 300
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494
Mailing Address - Country:US
Mailing Address - Phone:832-856-4600
Mailing Address - Fax:
Practice Address - Street 1:1259 FM 1463
Practice Address - Street 2:SUITE 300
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494
Practice Address - Country:US
Practice Address - Phone:832-856-4600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-04
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty