Provider Demographics
NPI:1902188147
Name:JONES, WENDY M (PA-C)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:M
Last Name:JONES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3399 E LOUISE DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-5047
Mailing Address - Country:US
Mailing Address - Phone:208-364-3000
Mailing Address - Fax:208-364-3191
Practice Address - Street 1:3399 E LOUISE DR
Practice Address - Street 2:SUITE 400
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-5047
Practice Address - Country:US
Practice Address - Phone:208-364-3000
Practice Address - Fax:208-364-3191
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AS0400X
IDPA-940363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical