Provider Demographics
NPI:1437309309
Name:JONES, JANUARY BANAAG (PA-C)
Entity Type:Individual
Prefix:
First Name:JANUARY
Middle Name:BANAAG
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 1:1645 N TOWN EAST BLVD
Mailing Address - Street 2:SUITE 174
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-4158
Mailing Address - Country:US
Mailing Address - Phone:972-270-5549
Mailing Address - Fax:972-270-5558
Practice Address - Street 1:1645 N TOWN EAST BLVD
Practice Address - Street 2:SUITE 174
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-4158
Practice Address - Country:US
Practice Address - Phone:972-270-5549
Practice Address - Fax:972-270-5558
Is Sole Proprietor?:No
Enumeration Date:2008-09-26
Last Update Date:2008-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05962363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical