MEDICARE: KRISTA GAIL 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	5473	CO
2	363A00000X	Physician Assistant	2021033601	MO

General Provider Information

NPI Number	:	1881160638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTA GAIL JONES PA-C

Provider Business Mailing Address
First Line	:	302 EAGLE AVE
Second Line	:
City	:	GRAVOIS MILLS
State	:	MO
Zip	:	65037-4623
Country	:	US
Telephone Number	:	970-397-2346
Fax Number	:	573-302-7138

Provider Business Practice Location Address
First Line	:	1029 NICHOLS RD STE 201
Second Line	:
City	:	OSAGE BEACH
State	:	MO
Zip	:	65065-3008
Country	:	US
Telephone Number	:	573-302-7138
Fax Number	:	573-302-4686

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

Provider Enumeration Date	:	10/19/2018
Last Update Date	:	08/26/2021

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