Provider Demographics
NPI:1912376104
Name:JONES, RICHARD ALAN JR (PA-C)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALAN
Last Name:JONES
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5554 S EDGEBERRY DR
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-7939
Mailing Address - Country:US
Mailing Address - Phone:541-701-4822
Mailing Address - Fax:
Practice Address - Street 1:9576 HWY 70
Practice Address - Street 2:
Practice Address - City:MINOCQUA
Practice Address - State:WI
Practice Address - Zip Code:54548-9067
Practice Address - Country:US
Practice Address - Phone:715-358-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-18
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024950363A00000X
FLPA9113223363A00000X
CT4802363A00000X
OH50.006414RX363A00000X
TN4128363A00000X
UT9515458-1206363A00000X
VA0110-007165363A00000X
MI5601009907363A00000X
SC3545363A00000X
WI8511363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant