Provider Demographics
NPI:1912921305
Name:JENNINGS-CONKLIN, KAREN S (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:S
Last Name:JENNINGS-CONKLIN
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:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:859-263-4666
Mailing Address - Fax:859-263-4666
Practice Address - Street 1:60 BRYAN BLVD STE 200
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-2781
Practice Address - Country:US
Practice Address - Phone:606-523-3021
Practice Address - Fax:606-528-7169
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34156207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64066822Medicaid
P00231447OtherRR MEDICARE
000000362844OtherANTHEM
P00231447OtherRR MEDICARE
H30863Medicare UPIN