MS. MARY JACK CONKLIN NP
NPI 1366526840
Nurse Practitioner - Gerontology in Walnut Creek, CA

Q: What is the provider's specialty?

The provider's specialty is Nurse Practitioner with taxonomy code 363LG0600X and a focus in Gerontology.

Active since October 24, 2006

1425 S MAIN ST, MOB 3RD FLOOR SURGERY CLINIC, WALNUT CREEK, CA 94596(925) 295-4659 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: July 19, 2026.

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About Ms. Mary Jack Conklin Np NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MS. MARY JACK CONKLIN NP (NPI 1366526840) is an individual gerontology provider in Walnut Creek, California, licensed in California (302434) and active in the NPI registry since October 2006.

NPPES Registry Identity

NPI1366526840

Entity TypeIndividualFemale

Primary Taxonomy363LG0600X

Provider Legal NameMS. MARY JACK CONKLINCredential: NP

Location Address1425 S MAIN ST, MOB 3RD FLOOR SURGERY CLINICWalnut Creek, CA 94596-5318

Mailing Address1425 S Main St, Mob 3rd Floor Surgery ClinicWalnut Creek, CA 94596-5318 · (925) 295-4110

Phone(925) 295-4659

Sole ProprietorNo

Enumeration DateOctober 24, 2006

Last NPPES UpdateJuly 8, 2007

✔ NPI 1366526840 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · GerontologyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LG0600X

License✔ Licensed in CA · 302434

1425 S MAIN ST, Walnut Creek, CA 94596

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Other Identifiers 1

Medicare UPINP18188CA

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. SARI FREDRICKSON MS, NP

Nurse Practitioner (Adult Health)