Basic Information
| Provider Information | |||||||||
| NPI: | 1912921305 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JENNINGS-CONKLIN | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 936 | ||||||||
| Address2: | |||||||||
| City: | LONDON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 407430936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592634666 | ||||||||
| FaxNumber: | 8592634666 | ||||||||
| Practice Location | |||||||||
| Address1: | 60 BRYAN BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | CORBIN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 407012781 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6065233021 | ||||||||
| FaxNumber: | 6065287169 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 08/20/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 34156 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 64066822 | 05 | KY | MEDICAID | P00231447 | 01 | RR MEDICARE | OTHER | 000000362844 | 01 | ANTHEM | OTHER |