Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 2017024370 | MO |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 2003016527 | MO |
NPI | 1104051523 |
---|---|
Provider Name | Sarah Lynn Jones |
First Address | Springfield, MO 65807-7304 |
Second Address | Springfield, MO 65804-2201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2009 |
Last Update Date | 13/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1104051523 | (05) | MO |
210793758 | (05) | AR |