Provider Demographics
NPI:1548282908
Name:JONES, WESLEY BRANDON (PA-C)
Entity type:Individual
Prefix:
First Name:WESLEY
Middle Name:BRANDON
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:US DEPARTMENT OF STATE 2401 E STREET NW SA-1
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20522-0001
Mailing Address - Country:US
Mailing Address - Phone:202-663-1662
Mailing Address - Fax:801-953-0941
Practice Address - Street 1:US DEPARTMENT OF STATE 2401 E STREET NW SA-1
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20522-0001
Practice Address - Country:US
Practice Address - Phone:202-663-1662
Practice Address - Fax:801-953-0941
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04533363A00000X
UT5723055-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX16335913OtherTEXAS DRIVERS LICENSE
TX8G6937Medicare ID - Type Unspecified