Provider Demographics
NPI:1982640298
Name:JONES, AMY K (PAC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:K
Last Name:JONES
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 N DUTTON AVE
Mailing Address - Street 2:CONCENTRA MEDICAL GROUP
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-4607
Mailing Address - Country:US
Mailing Address - Phone:707-543-8360
Mailing Address - Fax:707-543-8361
Practice Address - Street 1:1221 N DUTTON AVE
Practice Address - Street 2:CONCENTRA MEDICAL GROUP
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4607
Practice Address - Country:US
Practice Address - Phone:707-543-8360
Practice Address - Fax:707-543-8361
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA00375363AS0400X
CA19618363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACE787EMedicare PIN
CAAN828RMedicare UPIN
CAAN828UMedicare UPIN
CACE787DMedicare PIN
CACE787GMedicare PIN
MAQ61742Medicare UPIN
CAAN828VMedicare UPIN
CAZZZ07334ZMedicare PIN
CACE787CMedicare PIN
CAAN828TMedicare UPIN
CAAN828YMedicare UPIN
CACE787BMedicare PIN
CACE787AMedicare PIN
CAAN828WMedicare UPIN
CAAN828XMedicare UPIN
CAAN828SMedicare UPIN
RI979004509Medicare ID - Type UnspecifiedRI MEDICARE
CACE787FMedicare PIN