Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 2011001943 | MO |
NPI | 1053617407 |
---|---|
Provider Name | Coleen R. Jones |
First Address | Saint Louis, MO 63110-2138 |
Second Address | Saint Louis, MO 63110-2138 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2011 |
Last Update Date | 06/05/2019 |