Provider Demographics
NPI:1760823785
Name:CONKLE, KRYSTLE MICHELLE
Entity Type:Individual
Prefix:MRS
First Name:KRYSTLE
Middle Name:MICHELLE
Last Name:CONKLE
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 1:89 W FAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-3253
Mailing Address - Country:US
Mailing Address - Phone:724-434-5433
Mailing Address - Fax:
Practice Address - Street 1:89 W FAYETTE ST
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-3253
Practice Address - Country:US
Practice Address - Phone:724-434-5433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker