Provider Demographics
NPI:1265457741
Name:JONES, SUSAN R (PA)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:R
Last Name:JONES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:RAE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:920 JUDSON ROAD
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601
Mailing Address - Country:US
Mailing Address - Phone:903-236-7020
Mailing Address - Fax:903-236-7093
Practice Address - Street 1:703 E MARSHALL AVE
Practice Address - Street 2:SUITE 1001
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5500
Practice Address - Country:US
Practice Address - Phone:903-753-7291
Practice Address - Fax:903-315-5000
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04886363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical