Basic Information
| Provider Information | |||||||||
| NPI: | 1477834893 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | BRANDI | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2805 DALLAS PKWY STE 640 | ||||||||
| Address2: | |||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750938724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2149830300 | ||||||||
| FaxNumber: | 2149830301 | ||||||||
| Practice Location | |||||||||
| Address1: | 1175 COOK RD STE 215 | ||||||||
| Address2: | |||||||||
| City: | ORANGEBURG | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291188201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8033953837 | ||||||||
| FaxNumber: | 8035365122 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2011 | ||||||||
| LastUpdateDate: | 01/11/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA10675 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 1477834893 | 01 | SC | NPI | OTHER | 1231PA | 05 | SC | MEDICAID | 1097061 | 01 | NCCPA CERTICATE NUMBER | OTHER |