Basic Information
Provider Information
NPI: 1154821213
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JONES-SMITH
FirstName: ALEXANDRA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: FNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 3768
Address2:  
City: MERCED
State: CA
PostalCode: 953443768
CountryCode: US
TelephoneNumber: 2097257149
FaxNumber: 2092012262
Practice Location
Address1: 9696 STEPHENS ST
Address2:  
City: DELHI
State: CA
PostalCode: 953159550
CountryCode: US
TelephoneNumber: 2096670702
FaxNumber: 2096676767
Other Information
ProviderEnumerationDate: 02/15/2018
LastUpdateDate: 12/10/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/10/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000X842520CAN Nursing Service ProvidersRegistered Nurse 
363LF0000X95008478CAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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