Basic Information
Provider Information
NPI: 1073775938
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JONES
FirstName: CHRYSTAL
MiddleName: S
NamePrefix: MS.
NameSuffix:  
Credential: AA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 840853
Address2:  
City: DALLAS
State: TX
PostalCode: 752840853
CountryCode: US
TelephoneNumber: 9722331999
FaxNumber: 9722333666
Practice Location
Address1: 1500 CITYWEST BLVD
Address2: STE. 300
City: HOUSTON
State: TX
PostalCode: 77042
CountryCode: US
TelephoneNumber: 7136204000
FaxNumber: 7134584229
Other Information
ProviderEnumerationDate: 07/01/2008
LastUpdateDate: 08/06/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/06/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367H00000X890GAN Physician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant 
367H00000X890TXY Physician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant 

No ID Information.


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