Basic Information
| Provider Information | |||||||||
| NPI: | 1366484461 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | GARY | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2631 CUNNINGHAM AVE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | JOPLIN | ||||||||
| State: | MO | ||||||||
| PostalCode: | 648041543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4176278967 | ||||||||
| FaxNumber: | 4176278951 | ||||||||
| Practice Location | |||||||||
| Address1: | 2817 MCCLELLAND BLVD | ||||||||
| Address2: | SUITE 224 | ||||||||
| City: | JOPLIN | ||||||||
| State: | MO | ||||||||
| PostalCode: | 648041629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4177815387 | ||||||||
| FaxNumber: | 4177817174 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 139525 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.