Provider Demographics
NPI:1457443558
Name:JONES, TERALEA D (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TERALEA
Middle Name:D
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:PO BOX 4035
Mailing Address - Street 2:
Mailing Address - City:BEEVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78104-4035
Mailing Address - Country:US
Mailing Address - Phone:361-358-9912
Mailing Address - Fax:361-358-7640
Practice Address - Street 1:302 SOUTH HILLSIDE DRIVE
Practice Address - Street 2:
Practice Address - City:BEEVILLE
Practice Address - State:TX
Practice Address - Zip Code:78102
Practice Address - Country:US
Practice Address - Phone:361-358-2392
Practice Address - Fax:361-358-7640
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00386363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0083HGOtherBCBS
TX673835Medicare ID - Type UnspecifiedBEEVILLE FAMILY PRACTICE