Individual
KIMBERLY L. CONKLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
01 SAGEBRUSH RD, ISLETA, NM 87022-0580
(505) 869-3200
(505) 869-4584
Mailing address
PO BOX 640, ISLETA, NM 87022-0640
(505) 869-3200
(505) 869-4584
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0117371
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1194738328
NPI
NM
05
—
30852081
—
NM
Enumeration date
03/18/2009
Last updated
03/18/2009
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