Provider Demographics
NPI:1255308656
Name:CONWAY, JILL K (PA-C)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:K
Last Name:CONWAY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5939 HARRY HINES BLVD
Mailing Address - Street 2:SUITE 400, MAIL CODE 9191
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-9191
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5939 HARRY HINES BLVD
Practice Address - Street 2:SUITE 400, MAIL CODE 9191
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-9191
Practice Address - Country:US
Practice Address - Phone:214-645-2422
Practice Address - Fax:214-645-2420
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04440363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180843801Medicaid
TX8N9852OtherBLUE CROSS BLUE SHIELD
TX180843801Medicaid
TX8N9852OtherBLUE CROSS BLUE SHIELD