1376584425 NPI number — LAVINIA D JONES CRNA

Table of content: LAVINIA D JONES CRNA (NPI 1376584425)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376584425 NPI number — LAVINIA D JONES CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JONES
Provider First Name:
LAVINIA
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376584425
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3531 LAKELAND DR STE 1060
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLOWOOD
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39232-8016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-420-5810
Provider Business Mailing Address Fax Number:
601-420-5811

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 JACKSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VICKSBURG
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39183-2519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-420-5810
Provider Business Practice Location Address Fax Number:
604-420-5811
Provider Enumeration Date:
06/09/2006

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: 363L00000X , with the licence number:  906111 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: R857248 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: 906111 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00695430 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 00126795 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".