Provider Demographics
NPI:1649583014
Name:CONROY, SEAN K (PA-C)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:K
Last Name:CONROY
Suffix:
Gender:M
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:PO BOX 969
Mailing Address - Street 2:
Mailing Address - City:DIGHTON
Mailing Address - State:KS
Mailing Address - Zip Code:67839-0969
Mailing Address - Country:US
Mailing Address - Phone:620-397-5321
Mailing Address - Fax:620-397-2823
Practice Address - Street 1:235 W VINE ST
Practice Address - Street 2:
Practice Address - City:DIGHTON
Practice Address - State:KS
Practice Address - Zip Code:67839-5089
Practice Address - Country:US
Practice Address - Phone:620-397-5321
Practice Address - Fax:620-397-2823
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2020-09-18
Deactivation Date:2020-08-28
Deactivation Code:
Reactivation Date:2020-09-18
Provider Licenses
StateLicense IDTaxonomies
NE1592363A00000X, 363A00000X
KS15-01390363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSP00862311OtherRR MEDICARE
KS115A00008Medicare PIN
MO115000008Medicare UPIN