Provider Demographics
NPI:1851917181
Name:BLISS, CONNOR EVAN (PA-C)
Entity Type:Individual
Prefix:
First Name:CONNOR
Middle Name:EVAN
Last Name:BLISS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:603 N DIERS AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-4987
Mailing Address - Country:US
Mailing Address - Phone:308-398-1147
Mailing Address - Fax:308-398-1149
Practice Address - Street 1:2908 W 39TH ST STE D
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-1245
Practice Address - Country:US
Practice Address - Phone:308-455-8023
Practice Address - Fax:308-455-8024
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-23
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE2505363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant