1770216202 NPI number — VALORIE ANNETTE JONES PMHNP

Table of content: VALORIE ANNETTE JONES PMHNP (NPI 1770216202)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770216202 NPI number — VALORIE ANNETTE JONES PMHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JONES
Provider First Name:
VALORIE
Provider Middle Name:
ANNETTE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PMHNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MYRICK
Provider Other First Name:
VALORIE
Provider Other Middle Name:
ANNETTE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1770216202
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3600 S NATIONAL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65807-7311
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-322-6622
Provider Business Mailing Address Fax Number:
417-350-1935

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2005 W ELM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROGERS
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72758-4018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-322-6622
Provider Business Practice Location Address Fax Number:
417-350-1935
Provider Enumeration Date:
07/01/2022

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: 363LP0808X , with the licence number:  2022033690 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: 221015 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 221015 . This is a "AR LICENSE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 288202758 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 420114276 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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