Individual
MISS JILL ALISON CONKLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
1141 N MONROE DR, XENIA, OH 45385-1619
(937) 372-3638
(937) 372-3642
Mailing address
2110 LEITER RD, MIAMISBURG, OH 45342-3660
(937) 914-7054
(937) 522-7685
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50000288
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50000288
OHIO LICENSE
OH
Enumeration date
11/08/2006
Last updated
09/17/2013
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