Provider Demographics
NPI:1073600805
Name:JONES, DAVID M (PA-C)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:JONES
Suffix:
Gender:M
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 1:740 S LIMESTONE
Mailing Address - Street 2:A301
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0284
Mailing Address - Country:US
Mailing Address - Phone:859-323-6494
Mailing Address - Fax:859-257-4682
Practice Address - Street 1:740 S LIMESTONE
Practice Address - Street 2:A301
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0284
Practice Address - Country:US
Practice Address - Phone:859-323-6494
Practice Address - Fax:859-257-4682
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA094363A00000X, 363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY37903705OtherMEDICAID LAB GROUP#
KYASC 1019OtherASC MEDICARE GROUP#
KY4000501OtherMEDICARE LAB GROUP#
KY3600818OtherASC MEDICAID GROUP#
KY95000949Medicaid
KY970020922OtherRR MEDICARE PIN#
KYCB 5773OtherRR MEDICARE GROUP#
KY3600818OtherASC MEDICAID GROUP#
KY970020922OtherRR MEDICARE PIN#