Individual
MS. KELLY RENEE CONKLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP
Contact information
Practice address
913 NW GARDEN VALLEY BLVD, ROSEBURG, OR 97471
(541) 440-1000
(541) 440-1230
Mailing address
913 NW GARDEN VALLEY BLVD, ROSEBURG, OR 97471
(541) 440-1000
(541) 440-1230
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
200450145NP
OR
363LF0000X
Family Nurse Practitioner
Primary
200450145NP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
93-1148588
EMPLOYER IDENTIFICATION
OR
Enumeration date
07/17/2006
Last updated
02/25/2026
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