Active NPI
Derrica Conklin
- Doula
- Fayetteville, AR
National Provider Identifier
1497139174
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Doula
- Practice address
- 3359 W Cornell Dr
Fayetteville, AR 72704-6775 - Phone
- (479) 200-8054
- NPI assigned
- Jul 13, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Doula | 374J00000X | AR | Primary |
Addresses
Primary practice location
3359 W Cornell Dr
Fayetteville, AR 72704-6775
Mailing address
3359 W Cornell Dr
Fayetteville, AR 72704-6775
Phone (479) 200-8054
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1436745600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1436745600000",
"number": "1497139174",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3359 W CORNELL DR",
"city": "FAYETTEVILLE",
"state": "AR",
"postal_code": "727046775",
"telephone_number": "479-200-8054"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3359 W CORNELL DR",
"city": "FAYETTEVILLE",
"state": "AR",
"postal_code": "727046775",
"telephone_number": "479-200-8054"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONKLIN",
"first_name": "DERRICA",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-07-13",
"last_updated": "2015-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "374J00000X",
"taxonomy_group": "",
"desc": "Doula",
"state": "AR",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.