Provider Demographics
NPI:1578195582
Name:JONES, TREVON JERRELL
Entity Type:Individual
Prefix:
First Name:TREVON
Middle Name:JERRELL
Last Name:JONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 RAVENWOOD VILLAGE DR APT 624
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-1637
Mailing Address - Country:US
Mailing Address - Phone:903-724-5933
Mailing Address - Fax:
Practice Address - Street 1:172 RAVENWOOD VILLAGE DR APT 624
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-1637
Practice Address - Country:US
Practice Address - Phone:903-724-5933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-07
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT83222255A2300X
TX390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer