Provider Demographics
NPI:1831220078
Name:JONES, JULIE BLAIR (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:BLAIR
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 1:100 W CROSS ST
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77864-2432
Mailing Address - Country:US
Mailing Address - Phone:936-348-3418
Mailing Address - Fax:936-348-5846
Practice Address - Street 1:100 W CROSS ST
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:TX
Practice Address - Zip Code:77864-2432
Practice Address - Country:US
Practice Address - Phone:936-348-3418
Practice Address - Fax:936-348-5846
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX02515363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1043078OtherNCCPA