Tracy Conklin, RN

Primary specialty

Cardiac Rehabilitation Registered NurseTaxonomy code 163WC3500X

License

130714-30 Issued in WI

Practice address

1100 Gateway CT
West Bend, WI 53095-8539

Phone

(262) 335-8669

NPI assigned

Jan 31, 2019

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

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1548892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548892800000",
    "number": "1437614765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1137 KINROSS CT",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530953825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 GATEWAY CT",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530958539",
            "telephone_number": "262-335-8669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONKLIN",
        "first_name": "TRACY",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-31",
        "last_updated": "2019-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC3500X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Cardiac Rehabilitation",
            "state": "WI",
            "license": "130714-30",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Ann Cichanofsky
• City of West Bend
• Christopher Anthony Clairmont, DMD
• Connor Claus
• Coastal Waters Counseling Services
• Jodi F Conway, PT
• Kerri Corcoran
• Peter L Cornelius
• Rashida Cottingham
• Kaylin Elaine Cox

• Cardiac Rehabilitation Registered Nurse in West Bend, WI
• Providers in West Bend, WI by specialty
• Cardiac Rehabilitation Registered Nurse in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.