1750657839 NPI number — LAURA BETH JONES FNP-BC

Table of content: LAURA BETH JONES FNP-BC (NPI 1750657839)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750657839 NPI number — LAURA BETH JONES FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JONES
Provider First Name:
LAURA
Provider Middle Name:
BETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MILLS
Provider Other First Name:
LAURA
Provider Other Middle Name:
BETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
FNP-BC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1750657839
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1021 MULBERRY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SELMER
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38375-3274
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
731-646-1781
Provider Business Mailing Address Fax Number:
731-646-1786

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1021 MULBERRY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SELMER
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38375-3274
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-646-1781
Provider Business Practice Location Address Fax Number:
731-646-1786
Provider Enumeration Date:
03/22/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  16557 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1035I07685 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com