Provider Demographics
NPI:1417234899
Name:JONES, REBECCA B (PA-C)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:B
Last Name:JONES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 S 38TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-1107
Mailing Address - Country:US
Mailing Address - Phone:402-559-7595
Mailing Address - Fax:
Practice Address - Street 1:987680 NEBRASKA MEDICAL CTR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-7680
Practice Address - Country:US
Practice Address - Phone:402-559-8678
Practice Address - Fax:402-559-2650
Is Sole Proprietor?:No
Enumeration Date:2011-11-14
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1914363A00000X, 363AM0700X
MN11052363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1417234899Medicaid
IA1558340968Medicaid
MN970006019Medicare PIN
MN1417234899Medicaid