Provider Demographics
NPI:1346421666
Name:HALL, JONI A (PA)
Entity Type:Individual
Prefix:PROF
First Name:JONI
Middle Name:A
Last Name:HALL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 LAKE POINTE PKWY STE 400
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4067
Mailing Address - Country:US
Mailing Address - Phone:281-494-0050
Mailing Address - Fax:
Practice Address - Street 1:1327 LAKE POINTE PWKY
Practice Address - Street 2:SUITE 400
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478
Practice Address - Country:US
Practice Address - Phone:281-494-0050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05189363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8Y3871OtherBCBS
TX8Y8289OtherBCBSTX
TX193117202Medicaid
TX193117201Medicaid
TX8K4657Medicare PIN
TX193117201Medicaid