Provider Demographics
NPI:1821406018
Name:JONES, ALICIA (PA)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:JONES
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 1:50 LEROY ST
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-1786
Mailing Address - Country:US
Mailing Address - Phone:315-261-6034
Mailing Address - Fax:315-261-6025
Practice Address - Street 1:8 GULF RD
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:NY
Practice Address - Zip Code:13625-3257
Practice Address - Country:US
Practice Address - Phone:315-262-2287
Practice Address - Fax:315-262-2279
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-31
Last Update Date:2019-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017572363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical