Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 4704249976 | MI |
NPI | 1013122522 |
---|---|
Provider Name | Beverly Ann Jones |
First Address | Memphis, TN 38138-2584 |
Second Address | Memphis, TN 38120-2112 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2007 |
Last Update Date | 04/01/2019 |