Healthcare Provider Details

I. General information

NPI: 1316060700
Provider Name (Legal Business Name): TIM K MCCONKEY M.ED.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 N SPRING ST
SHELBYVILLE TN
37160-3966
US

IV. Provider business mailing address

207 N SPRING ST
SHELBYVILLE TN
37160-3966
US

V. Phone/Fax

Practice location:
  • Phone: 931-684-6200
  • Fax: 931-684-3377
Mailing address:
  • Phone: 931-684-6200
  • Fax: 931-684-3377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPE1320
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: