Jaquan Jamak Conway

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

Practice address

6030 E State Blvd
Fort Wayne, IN 46815-7639

Phone

(260) 452-0554

Fax

(260) 246-6374

NPI assigned

Apr 6, 2026

Last updated

Apr 6, 2026By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Personal Control and Wellness Consulting Group LLC

  • Community/Behavioral Health Agency
  • Fort Wayne, IN
  • NPI 1174295489
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1775433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775433600000",
    "number": "1689515306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6030 E STATE BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468157639",
            "telephone_number": "260-452-0554",
            "fax_number": "260-246-6374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6030 E STATE BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468157639",
            "telephone_number": "260-452-0554",
            "fax_number": "260-246-6374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONWAY",
        "first_name": "JAQUAN",
        "middle_name": "JAMAK",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2026-04-06",
        "last_updated": "2026-04-06",
        "certification_date": "2026-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Consulting & Counseling Associates, LLC
• Alexandria Contreraz, LMT
• Kiara Converse
• Kimberly Sue Converse, OT
• Gabrielle Conway, DO
• Krystal Conway
• Michael W Conway, MD
• Richard Edwin Conway
• Colleen Conwell, FNP-C
• Cook Behavioral Health Clinic, PC (Cook Behavioral Health)

• Community Health Worker in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Community Health Worker in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.