Provider Demographics
NPI:1891824454
Name:CONNER, JILL (NP)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:
Last Name:CONNER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3635 NELSON ROAD
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-0000
Mailing Address - Country:US
Mailing Address - Phone:337-477-0011
Mailing Address - Fax:337-477-0010
Practice Address - Street 1:3635 NELSON ROAD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-0000
Practice Address - Country:US
Practice Address - Phone:337-477-0011
Practice Address - Fax:337-477-0010
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA03563363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4B829CM87Medicare ID - Type Unspecified