Provider Demographics
NPI:1477831121
Name:CONNORS, JOHN T (NP-C)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:T
Last Name:CONNORS
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:301 FISHER ST
Mailing Address - Street 2:
Mailing Address - City:KEESLER AFB
Mailing Address - State:MS
Mailing Address - Zip Code:39534-2519
Mailing Address - Country:US
Mailing Address - Phone:228-376-3747
Mailing Address - Fax:228-376-0593
Practice Address - Street 1:359 MEDICAL GROUP
Practice Address - Street 2:221 THIRD STREET WEST, BLDG. 1040
Practice Address - City:JBSA-RANDOLPH AFB
Practice Address - State:TX
Practice Address - Zip Code:78150
Practice Address - Country:US
Practice Address - Phone:201-652-4264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-29
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904871363LF0000X
AZTAP4120363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS9183827Medicaid