Daryl Gene Conklin in Mossyrock - Physician Assistant
Daryl Gene Conklin - NPI 1902900020
Daryl Gene Conklin is a Physician Assistant in Mossyrock, Washington. Daryl Gene Conklin practices all healthcare services and medical treatments related to Physician Assistant. The NPI Number for Daryl Gene Conklin is 1902900020. The last update date is 2007-07-09.
Daryl Gene Conklin's current location address is 233 Willaims Ave, Mossyrock, Washington. You can contact this provider via phone number 3609833069 and fax number 3609833098. The mailing address for Daryl Gene Conklin is 233 Willaims Ave, Mossyrock, Washington. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Daryl Gene Conklin |
|---|---|
| Address | 233 Willaims Ave, Mossyrock, Washington |
| Phone Number | 3609833069 |
| Fax Number | 3609833098 |
| Sole Proprietor | Y |
| Credentials | PAC |
NPI Number Detail
| NPI Number | 1902900020 |
|---|---|
| Provider Enumeration Date | 2006-09-11 |
| Last Updated Date | 2007-07-09 |
Provider Mailing Address Detail
| Address | 233 Willaims Ave |
|---|---|
| City | Mossyrock |
| State | Washington (WA) |
| Post Code | 985640508 |
| Phone Number | 3609833069 |
| Fax Number | 3609833098 |
Provider's Primary Taxonomy Detail
| Speciality | Physician Assistant |
|---|---|
| Taxonomy | 363A00000X |
| Licence No | PA10002577 |
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Definition: A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perfor |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 8374738 | WA | -- | |
| 1100687 | WA | COMMUNITY HEALTH | |
| CO3874 | WA | REGENCE RIDER |
Post Comment/ Review Below
What is the Daryl Gene Conklin's specialty and taxonomy code?
The Daryl Gene Conklin's specialty is Physician Assistant, and the corresponding taxonomy code is 363A00000X.
When was the Daryl Gene Conklin's 1902900020 issued?
The Daryl Gene Conklin's 1902900020 was issued on 2006-09-11.
On what date did the Centers for Medicare & Medicaid Services issue the 1902900020 to Daryl Gene Conklin?
The Daryl Gene Conklin received its 1902900020 assignment from the Centers for Medicare & Medicaid Services on 2006-09-11.
When was the Daryl Gene Conklin's information last updated?
The Daryl Gene Conklin's information was last updated on 2007-07-09.
When was the information pertaining to Daryl Gene Conklin most recently updated or revised?
The details related to Daryl Gene Conklin, including its address, specialty, and other relevant information, were last updated or revised on 2007-07-09.