Individual
STACY A MCCONKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
15502 STONEYBROOK WEST PKWY, SUITE 2-108, WINTER GARDEN, FL 34787-4767
(407) 656-0042
(407) 656-0663
Mailing address
15502 STONEYBROOK WEST PKWY, SUITE 2-108, WINTER GARDEN, FL 34787-4767
(407) 656-0042
(407) 656-0663
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
32386
IA
208000000X
Pediatrics Physician
Primary
ME 113754
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0251819
—
IA
01
—
43666
WELLMARK BCBS
IA
Enumeration date
09/19/2005
Last updated
07/29/2013
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