Provider Demographics
NPI:1720470099
Name:CONKLIN, CAROLYN (NP-C)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:CONKLIN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 BRIARCLIFF DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-3068
Mailing Address - Country:US
Mailing Address - Phone:972-904-6376
Mailing Address - Fax:
Practice Address - Street 1:8160 WALNUT HILL LN STE 306
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4391
Practice Address - Country:US
Practice Address - Phone:214-345-8060
Practice Address - Fax:214-345-8229
Is Sole Proprietor?:No
Enumeration Date:2015-02-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX750229163W00000X
TXAP139905363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse