Provider Demographics
NPI:1780745679
Name:JONES, RANDI L (PA-C)
Entity type:Individual
Prefix:
First Name:RANDI
Middle Name:L
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 1:2535 W. OAK STREET
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201
Mailing Address - Country:US
Mailing Address - Phone:940-382-1577
Mailing Address - Fax:940-387-5471
Practice Address - Street 1:2535 W. OAK STREET
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201
Practice Address - Country:US
Practice Address - Phone:940-382-1577
Practice Address - Fax:940-387-5471
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04957363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00954314OtherRAILROAD MEDICARE
TXP00453355OtherRAILROAD MEDICARE
TX714778OtherMEDICARE PART B
TX8Y1403OtherBC/BS TEXAS
TX1780745679OtherNPI
TX835N04OtherBCBS TX 02/01/2011
TXTXB120921OtherMEDICARE PART B - EFFECT 02/01/2011
TX6484850005Medicare NSC
TX8F4920Medicare ID - Type UnspecifiedMEDICARE PART B NUMBER