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General NPI Number Information
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NPI Number | 1255308656
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Entity Type | Individual
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Provider Name | JILL K. CONWAY PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/03/2006
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Last Update Date | 03/04/2011
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Provider Practice Location Address
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Address Line | 5939 HARRY HINES BLVD SUITE 400, MAIL CODE 9191
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City | DALLAS
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State | TX
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Zip | 75390-9191
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Country | US
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Telephone | 214-645-2422
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Fax | 214-645-2420
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Provider Business Mailing Address
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Address Line | 5939 HARRY HINES BLVD SUITE 400, MAIL CODE 9191
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City | DALLAS
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State | TX
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Zip | 75390-9191
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA04440
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License Number State | TX
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