Kimberly L. Conklan – Professional Counselor

Key facts

NPI: 1649411851
Entity type: Individual (NPI type 1)
Primary specialty: Professional Counselor 101YP2500X
License: 0117371 (OK)
Practice address: 01 Sagebrush Rd
Isleta, NM 87022-0580
Phone: (505) 869-3200
Fax: (505) 869-4584
NPI assigned: Mar 18, 2009
Sex: Female
Sole proprietor: No

Organizations & group practices 1

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

Pueblo of Isleta Public Health Dentistry · Isleta, NM · NPI 1225158348

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
0117371	OK	MD	Professional Counselor

Practice roles

Organization	Specialty	Status	New patients
Pueblo of Isleta		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Professional Counselor	101YP2500X	0117371	OK	Yes

Addresses

Primary practice location

01 Sagebrush Rd
Isleta, NM 87022-0580

Mailing address

PO Box 640
Isleta, NM 87022-0640
Phone (505) 869-3200

Other identifiers

Identifier	Type	State	Issuer
1194738328	Other	NM	NPI
30852081	Medicaid	NM

Other providers in Isleta, NM

All providers in Isleta, NM · Professional Counselor in New Mexico

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 18, 2009. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.