Provider Demographics
NPI:1124578455
Name:JONES, CHESTER RAY IV (AGNP)
Entity Type:Individual
Prefix:MR
First Name:CHESTER
Middle Name:RAY
Last Name:JONES
Suffix:IV
Gender:M
Credentials:AGNP
Other - Prefix:
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Mailing Address - Street 1:4502 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4402
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:950 E BELT LINE RD STE 150
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-2424
Practice Address - Country:US
Practice Address - Phone:972-291-7863
Practice Address - Fax:972-291-0942
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-11
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131226363LA2200X, 363LG0600X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology