Provider Demographics
NPI:1629072277
Name:CLINE, JONI (PA)
Entity Type:Individual
Prefix:
First Name:JONI
Middle Name:
Last Name:CLINE
Suffix:
Gender:F
Credentials:PA
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 16327
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79490-6327
Mailing Address - Country:US
Mailing Address - Phone:806-795-8150
Mailing Address - Fax:806-791-6688
Practice Address - Street 1:4404 19TH ST STE C
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79407-2424
Practice Address - Country:US
Practice Address - Phone:806-795-8150
Practice Address - Fax:806-791-6688
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00226363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM98701266Medicaid
TXS38779Medicare UPIN
8J7141Medicare PIN