Healthcare Provider Details

I. General information

NPI: 1629072277
Provider Name (Legal Business Name): JONI CLINE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 11/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4404 19TH ST STE C
LUBBOCK TX
79407-2424
US

IV. Provider business mailing address

PO BOX 16327
LUBBOCK TX
79490-6327
US

V. Phone/Fax

Practice location:
  • Phone: 806-795-8150
  • Fax: 806-791-6688
Mailing address:
  • Phone: 806-795-8150
  • Fax: 806-791-6688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA00226
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00226
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: