Provider Demographics
NPI:1306447032
Name:JONES, JENNIFER LEANNE (PA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEANNE
Last Name:JONES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 23RD ST
Mailing Address - Street 2:
Mailing Address - City:CANYON
Mailing Address - State:TX
Mailing Address - Zip Code:79015-4645
Mailing Address - Country:US
Mailing Address - Phone:806-655-2104
Mailing Address - Fax:806-655-0522
Practice Address - Street 1:911 23RD ST
Practice Address - Street 2:
Practice Address - City:CANYON
Practice Address - State:TX
Practice Address - Zip Code:79015-4645
Practice Address - Country:US
Practice Address - Phone:806-655-2104
Practice Address - Fax:806-655-0522
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty