Provider Demographics
NPI:1629321047
Name:OWENS, JODI (PA-C)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:OWENS
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 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:254-724-8800
Mailing Address - Fax:
Practice Address - Street 1:1700 RR 620 S
Practice Address - Street 2:SUITE B
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-6245
Practice Address - Country:US
Practice Address - Phone:512-263-9111
Practice Address - Fax:512-263-3122
Is Sole Proprietor?:No
Enumeration Date:2012-10-23
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02553363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical