Provider Demographics
NPI:1477834893
Name:JONES, BRANDI L (PA-C)
Entity Type:Individual
Prefix:MS
First Name:BRANDI
Middle Name:L
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 1:2805 DALLAS PKWY STE 640
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8724
Mailing Address - Country:US
Mailing Address - Phone:214-983-0300
Mailing Address - Fax:214-983-0301
Practice Address - Street 1:1175 COOK RD STE 215
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-8201
Practice Address - Country:US
Practice Address - Phone:803-395-3837
Practice Address - Fax:803-536-5122
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA10675363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1477834893OtherNPI
SC1231PAMedicaid
1097061OtherNCCPA CERTICATE NUMBER
SC1477834893OtherNPI