Basic Information
| Provider Information | |||||||||
| NPI: | 1427383447 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | REESE | ||||||||
| MiddleName: | DAYLEN | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1250 S CLEARVIEW AVE STE 100 | ||||||||
| Address2: | URGENT CARE EXTRA | ||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852093378 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4809889108 | ||||||||
| FaxNumber: | 4808134460 | ||||||||
| Practice Location | |||||||||
| Address1: | 1355 S HIGLEY RD STE 104 | ||||||||
| Address2: | URGENT CARE EXTRA | ||||||||
| City: | GILBERT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852964799 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808406600 | ||||||||
| FaxNumber: | 4808406699 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/08/2009 | ||||||||
| LastUpdateDate: | 08/24/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 4493 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 468565 | 05 | AZ | MEDICAID | 651170616 | 01 | AZ | TAX ID | OTHER | Z133622 | 01 | AZ | MEDICARE PTAN | OTHER |