Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003323460 |
---|---|
Provider Name | Kristy Kerchell Jones |
First Address | Sterlington, LA 71280-3004 |
Second Address | Ruston, LA 71270-5801 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2018 |
Last Update Date | 03/09/2019 |