Individual
MR. RICHARD M MCCONKIE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP-C
Contact information
Practice address
4740 N PENNGROVE WAY, MERIDIAN, ID 83646-7443
(208) 514-0203
Mailing address
PO BOX 277976, ATLANTA, GA 30384-7976
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
NP 1302 A
ID
Other
Enumeration date
07/09/2013
Last updated
05/23/2024
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