Healthcare Provider Details

I. General information

NPI: 1124935622
Provider Name (Legal Business Name): RYAN JONES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24025 N 23RD AVE UNIT 9103
PHOENIX AZ
85085-2045
US

IV. Provider business mailing address

24025 N 23RD AVE UNIT 9103
PHOENIX AZ
85085-2045
US

V. Phone/Fax

Practice location:
  • Phone: 208-921-8983
  • Fax:
Mailing address:
  • Phone: 208-921-8983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: