Tina Marie Conklin

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

200330020LPN Issued in OR

Practice address

3099 NE Diamond Lake Blvd
Roseburg, OR 97470-3655

Phone

(541) 673-3469

NPI assigned

Jul 22, 2021

Last updated

Jul 31, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1626912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690761600000",
    "number": "1447823810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1121",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974700254",
            "telephone_number": "541-672-2691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3099 NE DIAMOND LAKE BLVD",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974703655",
            "telephone_number": "541-673-3469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONKLIN",
        "first_name": "TINA",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-22",
        "last_updated": "2023-07-31",
        "certification_date": "2023-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "OR",
            "license": "200330020LPN",
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "OR",
            "license": "21-QMHA-R-1339",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Community Health Alliance
• Community Health Alliance
• Meredith Ann Concepcion, LCSW
• Josie Dion Congdon, MSW, QMHP, CSWA
• Kelly Renee Conklin, DNP
• Leslie Conlee, BS
• Julie Connors
• Wyndham Marie Noel Conway
• Brian Austin Cook-Lindsay, DPT
• Cimberly Cook

• Licensed Practical Nurse in Roseburg, OR
• Providers in Roseburg, OR by specialty
• Licensed Practical Nurse in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2023; 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.