Provider Demographics
NPI:1750791240
Name:JONES, NATHANIEL GREY (PA-C)
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:GREY
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 1:1604 HOSPITAL PKWY STE 501
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-6932
Mailing Address - Country:US
Mailing Address - Phone:817-684-2700
Mailing Address - Fax:817-684-2709
Practice Address - Street 1:1604 HOSPITAL PKWY STE 501
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6932
Practice Address - Country:US
Practice Address - Phone:817-684-2700
Practice Address - Fax:817-684-2709
Is Sole Proprietor?:No
Enumeration Date:2014-05-06
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA09140363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX338747401Medicaid
TX338747402Medicaid
TX338747402Medicaid
TX364449YKQLMedicare PIN