Provider Demographics
NPI:1144295205
Name:CONKLIN, MICHELLE E (M D)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:E
Last Name:CONKLIN
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 W T WEAVER BLVD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804-3415
Mailing Address - Country:US
Mailing Address - Phone:828-257-4730
Mailing Address - Fax:828-257-4738
Practice Address - Street 1:118 W T WEAVER BLVD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804-3415
Practice Address - Country:US
Practice Address - Phone:828-257-4730
Practice Address - Fax:828-257-4738
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC172982390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010211221Medicaid
VA008438P95 - C03895Medicare ID - Type Unspecified
VA010211221Medicaid