Healthcare Provider Details

I. General information

NPI: 1912921305
Provider Name (Legal Business Name): KAREN S JENNINGS-CONKLIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 08/20/2020
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 BRYAN BLVD STE 200
CORBIN KY
40701-2781
US

IV. Provider business mailing address

PO BOX 936
LONDON KY
40743-0936
US

V. Phone/Fax

Practice location:
  • Phone: 606-523-3021
  • Fax: 606-528-7169
Mailing address:
  • Phone: 859-263-4666
  • Fax: 859-263-4666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number34156
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: