MEDICARE: MRS. GINA G JONES PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	1074241	TX
2	363A00000X	Physician Assistant	PA04954	TX

General Provider Information

NPI Number	:	1043387731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GINA G JONES PA-C

Provider Business Mailing Address
First Line	:	728 JOHNS WELL CT
Second Line	:
City	:	ARGYLE
State	:	TX
Zip	:	76226-1729
Country	:	US
Telephone Number	:	386-547-0975
Fax Number	:	254-267-1049

Provider Business Practice Location Address
First Line	:	2425 HWY 121
Second Line	:
City	:	BEDFORD
State	:	TX
Zip	:	76021-5011
Country	:	US
Telephone Number	:	817-540-4477
Fax Number	:	817-510-0188

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	12/09/2019

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