Provider Demographics
NPI:1225097389
Name:JONES, AMI S (PA C)
Entity Type:Individual
Prefix:
First Name:AMI
Middle Name:S
Last Name:JONES
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:AMI
Other - Middle Name:S
Other - Last Name:WEGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3755
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-0755
Mailing Address - Country:US
Mailing Address - Phone:402-354-2100
Mailing Address - Fax:402-354-6171
Practice Address - Street 1:426 E 22ND ST STE 100
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2633
Practice Address - Country:US
Practice Address - Phone:402-727-7796
Practice Address - Fax:402-727-9574
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE939363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026480114Medicaid
P00337632OtherPALMETTO - GBA
277793Medicare ID - Type Unspecified