Provider Demographics
NPI:1184200792
Name:JONES, AMANDA BROOK (PA-C)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:BROOK
Last Name:JONES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:BROOK
Other - Last Name:BARLOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1335 N GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83204-2629
Mailing Address - Country:US
Mailing Address - Phone:435-932-1002
Mailing Address - Fax:
Practice Address - Street 1:300 3RD ST
Practice Address - Street 2:
Practice Address - City:RAWLINS
Practice Address - State:WY
Practice Address - Zip Code:82301-5612
Practice Address - Country:US
Practice Address - Phone:307-324-8494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical