Miranda K Conklin, LAT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

082946 Issued in IA

Practice address

408 Adams St
Muscatine, IA 52761-5128

Phone

(563) 260-9101

NPI assigned

Sep 2, 2015

Last updated

Jan 23, 2019By 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 1

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": "1441152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548201600000",
    "number": "1659749091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "408 ADAMS ST",
            "city": "MUSCATINE",
            "state": "IA",
            "postal_code": "527615128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "408 ADAMS ST",
            "city": "MUSCATINE",
            "state": "IA",
            "postal_code": "527615128",
            "telephone_number": "563-260-9101"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1405 N Elm St Ste 101",
            "address_purpose": "LOCATION",
            "city": "West Liberty",
            "state": "IA",
            "postal_code": "527761030",
            "country_code": "US",
            "telephone_number": "563-260-9101",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CONKLIN",
        "first_name": "MIRANDA",
        "middle_name": "K",
        "credential": "LAT, ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-02",
        "last_updated": "2019-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IA",
            "license": "082946",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Athletic Trainer in Muscatine, IA
• Providers in Muscatine, IA by specialty
• Athletic Trainer in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 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.