NPIMap

Individual provider Active NPI

Katy Konkle, MD

  • Urology Physician
  • Pueblo, CO
National Provider Identifier
1467749978
Registry record updated Jul 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
DR.0059044 Issued in CO
Practice address
3676 Parker Blvd
Ste 280
Pueblo, CO 81008-2214
Phone
(719) 595-8505
Fax
(719) 595-8509
NPI assigned
Jul 5, 2011
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 7, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X DR.0059044 CO Primary
Urology Physician 208800000X 316047 NY

Addresses

Primary practice location

3676 Parker Blvd
Ste 280
Pueblo, CO 81008-2214

Mailing address

PO Box 560825
Denver, CO 80256-0825
Phone (719) 595-7580

Other practice location 1

15 Degrandpre Way
Plattsburgh, NY 12901-6449
Phone (518) 314-3900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, OR2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210929003683 WA Practitioner - Urology 2163730417 Reassigns benefits to 3 organizations
I20250414003068 OR Practitioner - Urology 2163730417 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Wayne State University School of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Franciscan Medical GroupGroup PAC ID 0547173866, 1,400 clinicians

Practice addresses (Care Compare)

1950 NW Myhre Rd
Silverdale, WA 98383-7662
Phone (560) 240-4000

725 S Wahanna Rd
Seaside, OR 97138-7735
Phone (503) 717-7000

727 S Wahanna Rd
Seaside, OR 97138-7735
Phone (503) 717-7000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
DR.0059044COMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services Oregon CurrentSince May 1, 2025 Accepting new patients
Valley Medical Group-Renton CurrentSince Jun 1, 2024 Accepting new patients
Franciscan Medical Group CurrentSince Nov 6, 2024 Accepting new patients
Public Hospital Dist No 1 Skagit CurrentSince Sep 13, 2021 Accepting new patients
Franciscan Medical Group CurrentSince Nov 6, 2024 Accepting new patients
Providence Health & Services Oregon CurrentSince May 1, 2025 Accepting new patients
Public Hospital Dist No 1 Skagit CurrentSince Sep 13, 2021 Accepting new patients
Franciscan Medical Group Current Accepting new patients
Providence Health & Services Oregon CurrentSince May 1, 2025 Accepting new patients
St Luke's Magic Valley Regional Medical Center LTD Past Accepting new patients

Locations

725 S Wahanna Rd
Seaside, OR 97138
Phone (503) 717-7000

16850 SE 272nd St
Ste 100
Covington, WA 98042
Phone (253) 395-1971

1400 E Kincaid St
Mount Vernon, WA 98274
Phone (360) 428-2586

4033 Talbot Rd S
Ste 500
Renton, WA 98055
Phone (425) 251-5110

1950 NW Myhre Rd
Silverdale, WA 98383
Phone (560) 240-4000

1812 S J St
Ste 120
Tacoma, WA 98405
Phone (253) 428-2200

Interoperability endpoints

  • Direct secure messaging: kkonkle187744@direct.slhs.org
  • Direct secure messaging: kkonkle121141@direct.valleymed.org

Organizations & group practices 10

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.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1309824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657152000000",
    "number": "1467749978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 560825",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802560825",
            "telephone_number": "719-595-7580",
            "fax_number": "719-545-0176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3676 PARKER BLVD",
            "address_2": "STE 280",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810082214",
            "telephone_number": "719-595-8505",
            "fax_number": "719-595-8509"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15 Degrandpre Way",
            "address_purpose": "LOCATION",
            "city": "Plattsburgh",
            "state": "NY",
            "postal_code": "129016449",
            "country_code": "US",
            "telephone_number": "518-314-3900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KONKLE",
        "first_name": "KATY",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-07-05",
        "last_updated": "2022-07-07",
        "certification_date": "2022-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "CO",
            "license": "DR.0059044",
            "primary": true
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NY",
            "license": "316047",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

Verify at the official NPI Registry.