Healthcare Provider Details

I. General information

NPI: 1720387830
Provider Name (Legal Business Name): JILL LEEANN CONNEALY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2011
Last Update Date: 08/19/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4425 COUNTY RD E
TEKAMAH NE
68061-4004
US

IV. Provider business mailing address

3519 HIGHWAY 32
TEKAMAH NE
68061-5095
US

V. Phone/Fax

Practice location:
  • Phone: 402-374-1585
  • Fax: 402-374-1612
Mailing address:
  • Phone: 402-374-1585
  • Fax: 402-374-1612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1578
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: