Provider Demographics
NPI:1316060700
Name:MCCONKEY, TIM K (MED)
Entity type:Individual
Prefix:MR
First Name:TIM
Middle Name:K
Last Name:MCCONKEY
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 N SPRING ST
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-3966
Mailing Address - Country:US
Mailing Address - Phone:931-684-6200
Mailing Address - Fax:931-684-3377
Practice Address - Street 1:207 N SPRING ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-3966
Practice Address - Country:US
Practice Address - Phone:931-684-6200
Practice Address - Fax:931-684-3377
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPE1320103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist