Active NPI
Autumn Lea Conklin
- Pediatric Registered Nurse
- Washington, PA
National Provider Identifier
1710273875
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Registered Nurse
- License
- RN626758
- Practice address
- 289 North Ave
Washington, PA 15301-3512 - Phone
- (724) 223-7801
- NPI assigned
- Jun 27, 2011
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pediatric Registered Nurse | 163WP0200X | RN626758 | PA | Primary |
Addresses
Primary practice location
289 North Ave
Washington, PA 15301-3512
Mailing address
4297 Prosperity Pike
Prosperity, PA 15329-1254
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN626758 | PA | MD | Pediatric Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Your Child'S Place | Pediatrics | Past | Accepting new patients |
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1309132800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1309132800000",
"number": "1710273875",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4297 PROSPERITY PIKE",
"city": "PROSPERITY",
"state": "PA",
"postal_code": "153291254"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "289 NORTH AVE",
"city": "WASHINGTON",
"state": "PA",
"postal_code": "153013512",
"telephone_number": "724-223-7801"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONKLIN",
"first_name": "AUTUMN",
"middle_name": "LEA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-06-27",
"last_updated": "2011-06-27",
"status": "A"
},
"taxonomies": [
{
"code": "163WP0200X",
"taxonomy_group": "",
"desc": "Registered Nurse, Pediatrics",
"state": "PA",
"license": "RN626758",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Washington, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.