Basic Information
Provider Information
NPI: 1225515679
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JONES
FirstName: ALTON
MiddleName: DION
NamePrefix:  
NameSuffix: JR.
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6983 HILLSDALE CT
Address2:  
City: INDIANAPOLIS
State: IN
PostalCode: 462502054
CountryCode: US
TelephoneNumber: 3173082800
FaxNumber: 3175766311
Practice Location
Address1: 8402 HARCOURT RD STE 615
Address2:  
City: INDIANAPOLIS
State: IN
PostalCode: 462602055
CountryCode: US
TelephoneNumber: 3178066991
FaxNumber: 3178066990
Other Information
ProviderEnumerationDate: 07/27/2018
LastUpdateDate: 03/16/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000X28192556AINN Nursing Service ProvidersRegistered Nurse 
363L00000X71008728AINY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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