Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 1169115 | AL |
NPI | 1063032704 |
---|---|
Provider Name | Mrs. Destinee Jones |
First Address | Town Creek, AL 35672-4026 |
Second Address | Decatur, AL 35601-2516 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2020 |
Last Update Date | 17/09/2021 |