Basic Information
| Provider Information | |||||||||
| NPI: | 1184777120 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3016 W CHARLESTON BLVD STE 205 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891021963 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027802312 | ||||||||
| FaxNumber: | 7028954014 | ||||||||
| Practice Location | |||||||||
| Address1: | 3121 S MARYLAND PKWY STE 400 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891092309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022502500 | ||||||||
| FaxNumber: | 7022502220 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2007 | ||||||||
| LastUpdateDate: | 01/08/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0120X | DO2170 | NV | Y | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery | 2086S0120X | A11813 | CA | N | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1184777120 | 05 | NV | MEDICAID |