Healthcare Provider Details

I. General information

NPI: 1114819778
Provider Name (Legal Business Name): ASHLEY MCCALL CONKLING RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2025
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13772 DENVER WEST PKWY
LAKEWOOD CO
80401-3139
US

IV. Provider business mailing address

13631 ASH CIR
THORNTON CO
80602-5903
US

V. Phone/Fax

Practice location:
  • Phone: 303-216-0333
  • Fax:
Mailing address:
  • Phone: 314-604-2804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number1661220
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: