Provider Demographics
NPI:1942205570
Name:JONES, DANIEL C (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:C
Last Name:JONES
Suffix:
Gender:M
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 1:12201 BLUEGRASS PKWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-2361
Mailing Address - Country:US
Mailing Address - Phone:502-568-7366
Mailing Address - Fax:502-568-7114
Practice Address - Street 1:919 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN CITY
Practice Address - State:TN
Practice Address - Zip Code:37683-1042
Practice Address - Country:US
Practice Address - Phone:423-727-7800
Practice Address - Fax:423-727-2498
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1107363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3662212Medicaid
4072278OtherBCBST
Q00325Medicare UPIN
TN103I972303Medicare PIN
4072278OtherBCBST
Q00325Medicare UPIN
3662212Medicare ID - Type Unspecified
3662212Medicare PIN