Provider Demographics
NPI:1356339626
Name:CONNORS, JESSE N (PA-C)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:N
Last Name:CONNORS
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 1:5701 W. CHARLESTON BLVD.
Mailing Address - Street 2:SUITE100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146
Mailing Address - Country:US
Mailing Address - Phone:702-877-9514
Mailing Address - Fax:702-312-3510
Practice Address - Street 1:5701 W CHARLESTON BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-1256
Practice Address - Country:US
Practice Address - Phone:702-877-9514
Practice Address - Fax:702-312-3510
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV506363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1356339626Medicaid
NV003102939Medicaid
NV100504094Medicaid