Provider Demographics
NPI:1760142210
Name:CONKLIN, MOLLY MAYERLE
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:MAYERLE
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 1:2950 OLD SPANISH TRL APT 243
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2244
Mailing Address - Country:US
Mailing Address - Phone:832-387-8404
Mailing Address - Fax:
Practice Address - Street 1:3306 CREEK SHADOWS DR
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-1289
Practice Address - Country:US
Practice Address - Phone:832-387-8404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-26
Last Update Date:2021-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1061190363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care