Kimberly June Conaboy

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

SP026041 Issued in PA

Practice address

102 N Abington Rd Ste 103
Clarks Green, PA 18411-2326

Phone

(570) 586-0246

NPI assigned

Aug 2, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Wayne Memorial Hospital

  • General Acute Care Hospital
  • Honesdale, PA
  • NPI 1124026182
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1659398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660521600000",
    "number": "1265169163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 N ABINGTON RD",
            "city": "CLARKS GREEN",
            "state": "PA",
            "postal_code": "184112300",
            "telephone_number": "570-586-0246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 N ABINGTON RD STE 103",
            "city": "CLARKS GREEN",
            "state": "PA",
            "postal_code": "184112326",
            "telephone_number": "570-586-0246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONABOY",
        "first_name": "KIMBERLY",
        "middle_name": "JUNE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-02",
        "last_updated": "2022-08-15",
        "certification_date": "2022-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "PA",
            "license": "SP026041",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adrianna Borkowski
• Brightway Medical PC
• Vincent Carolan, MA, CAADC, LPC
• Nicholas Chupick, PTA
• Terence A Cochran, M.D.
• Colleen Contrisciane, LPC
• Diagnostic Imaging Centers of Nepa, LLC (Advanced Imaging Specialists)
• Jessica Failing
• Mariah Ford
• Tiffany Ann Frisbie, PTA

• Nurse Practitioner in Clarks Green, PA
• Providers in Clarks Green, PA by specialty
• Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.