Healthcare Provider Details

I. General information

NPI: 1740825264
Provider Name (Legal Business Name): JOHNNA JONES DO FACOS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2019
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 AIRPORT FWY STE 103
BEDFORD TX
76021-6603
US

IV. Provider business mailing address

5204 LONG SHOT RD
FORT WORTH TX
76114-1253
US

V. Phone/Fax

Practice location:
  • Phone: 469-320-1267
  • Fax:
Mailing address:
  • Phone: 682-647-6500
  • Fax: 855-227-8089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHNNA JONES
Title or Position: MD
Credential:
Phone: 682-647-6500