Healthcare Provider Details

I. General information

NPI: 1811685209
Provider Name (Legal Business Name): TAYLOR CONKEL BSN, RNC-MNN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2023
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 WILMA ST
TYLER TX
75701-5644
US

IV. Provider business mailing address

1217 WILMA ST
TYLER TX
75701-5644
US

V. Phone/Fax

Practice location:
  • Phone: 903-805-0233
  • Fax:
Mailing address:
  • Phone: 903-805-0233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number899812
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: