Basic Information
| Provider Information | |||||||||
| NPI: | 1255588067 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | Y | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1112 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ROSWELL | ||||||||
| State: | NM | ||||||||
| PostalCode: | 882015010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5756274200 | ||||||||
| FaxNumber: | 5756274212 | ||||||||
| Practice Location | |||||||||
| Address1: | 1112 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ROSWELL | ||||||||
| State: | NM | ||||||||
| PostalCode: | 882015010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5756274200 | ||||||||
| FaxNumber: | 5756274212 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2008 | ||||||||
| LastUpdateDate: | 10/26/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | CNP00283 | NM | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 52085261 | 05 | NM | MEDICAID |