Provider Demographics
NPI:1811178031
Name:JONES, KEITH EDWARD (PA-C)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:EDWARD
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:PO BOX 459
Mailing Address - Street 2:
Mailing Address - City:GROVETON
Mailing Address - State:TX
Mailing Address - Zip Code:75845-0459
Mailing Address - Country:US
Mailing Address - Phone:936-642-0841
Mailing Address - Fax:936-309-0086
Practice Address - Street 1:110 MAGEE STREET
Practice Address - Street 2:
Practice Address - City:GROVETON
Practice Address - State:TX
Practice Address - Zip Code:75845
Practice Address - Country:US
Practice Address - Phone:936-642-0841
Practice Address - Fax:936-642-0849
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03871363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX203876201Medicaid
TX203876202Medicaid
TX673854Medicare UPIN
TX203876201Medicaid