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1205377306 NPI number — JORDAN D'NELLE JONES PA-C

NPI Number: 1205377306
Health Care Provider/Practitioner: JORDAN D'NELLE JONES PA-C

Information about “1205377306” NPI (JORDAN D'NELLE JONES PA-C) exists in 1205377306 in HTML format HTML  |  1205377306 in plain Text format TXT  |  1205377306 in PDF (Portable Document Format) PDF  |  1205377306 in an XML format XML  formats.

NPI Number : 1205377306 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1205377306",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "JONES",
    "FirstName": "JORDAN",
    "MiddleName": "D'NELLE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PA-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2218 POLO PARK DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DAYTON",
    "MailingAddressStateName": "OH",
    "MailingAddressPostalCode": "45439-3267",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "612-940-4029",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1507 RIVERY BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GEORGETOWN",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "78628-3058",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "512-509-5990",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/09/2017",
    "LastUpdateDate": "06/30/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": "PA2019-002",
          "LicenseNumberStateCode": "NM",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": "50.005032RX",
          "LicenseNumberStateCode": "OH",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": "024606",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": "MA061706",
          "LicenseNumberStateCode": "PA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": "55556",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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