Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MO2008013239 | MO |
N | 207QG0300X | Family Doctor - Geriatric Medicine | MO2008013239 | MO |
NPI | 1215965314 |
---|---|
Provider Name | Dr. Crystal L Jones |
First Address | Sedalia, MO 65301-2540 |
Second Address | Clinton, MO 64735-1192 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 15/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2008013239 | STATE LISCENSE (01) | MO |
605992335 | BNDD (01) | MO |
FJ3241421 | DEA (01) | MO |
RES000 | (02) | MO |