Provider Demographics
NPI:1881160638
Name:JONES, KRISTA GAIL (PA-C)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:GAIL
Last Name:JONES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:302 EAGLE AVE
Mailing Address - Street 2:
Mailing Address - City:GRAVOIS MILLS
Mailing Address - State:MO
Mailing Address - Zip Code:65037-4623
Mailing Address - Country:US
Mailing Address - Phone:970-397-2346
Mailing Address - Fax:573-302-7138
Practice Address - Street 1:1029 NICHOLS RD STE 201
Practice Address - Street 2:
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-3008
Practice Address - Country:US
Practice Address - Phone:573-302-7138
Practice Address - Fax:573-302-4686
Is Sole Proprietor?:No
Enumeration Date:2018-10-19
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO5473363A00000X
MO2021033601363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant