Provider Demographics
NPI:1356544951
Name:CONKLING, KRISTIN DIANE (MD)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:DIANE
Last Name:CONKLING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5125 E 107TH PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-7236
Mailing Address - Country:US
Mailing Address - Phone:254-718-8654
Mailing Address - Fax:
Practice Address - Street 1:5125 E 107TH PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-7236
Practice Address - Country:US
Practice Address - Phone:254-718-8654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK198042080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine