Basic Information
| Provider Information | |||||||||
| NPI: | 1366582025 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CONIGLIO | ||||||||
| FirstName: | DESIREE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | R.N., APRN/NP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CRYTS | ||||||||
| OtherFirstName: | DESIREE | ||||||||
| OtherMiddleName: | |||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 747 | ||||||||
| Address2: | |||||||||
| City: | MANHATTAN | ||||||||
| State: | KS | ||||||||
| PostalCode: | 665050747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7855874300 | ||||||||
| FaxNumber: | 7855874377 | ||||||||
| Practice Location | |||||||||
| Address1: | 2001 CLAFLIN RD | ||||||||
| Address2: | |||||||||
| City: | MANHATTAN | ||||||||
| State: | KS | ||||||||
| PostalCode: | 665023415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7855874300 | ||||||||
| FaxNumber: | 7855874305 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2007 | ||||||||
| LastUpdateDate: | 02/06/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 163W00000X | 14116330101 | KS | N | Nursing Service Providers | Registered Nurse | 163WP0807X | 733034 | CA | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health, Child & Adolescent | 163WP0808X | 143094 | KS | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health | 363LP0808X | 143100 | KS | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 363LP0808X | 5375505101 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 200739840A | 05 | KS | MEDICAID |