Healthcare Provider Details

I. General information

NPI: 1326838897
Provider Name (Legal Business Name): JILLIAN E OWENS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2025
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 S 63RD ST
MESA AZ
85206-1618
US

IV. Provider business mailing address

15424 S 26TH WAY
PHOENIX AZ
85048-8993
US

V. Phone/Fax

Practice location:
  • Phone: 480-835-6100
  • Fax:
Mailing address:
  • Phone: 602-510-3486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: